Podcasts about snris

Send Me a Message! After years of trying a myriad of psychiatric medications—SSRIs, SNRIs, NDRI's, Tricyclics (TCA), mood stabilisers, antipsychotics, stimulants, benzodiazepines, and everything in between—I've reached a breaking point. Nothing has truly worked, my anxiety has never been worse, and the side effects are piling up. My body's jittery, my mind's exhausted, and I'm stuck somewhere between sedation and overstimulation.In this episode, I open up about my plea for a full medication reset. I am wanting to strip things back and start again—clean slate, clean brain. But getting support for that? A whole other battle. This episode is about what it's like to fight for your own mental clarity when everything you've tried has left you feeling worse.--Follow my journey living with mental illness and the hard-fought lessons learned along the way. Lived experience is the driving force of this podcast, and through this lens, my stories are told. This is a raw, honest, and authentic account of how multiple psychological disorders have shaped my past and continue to influence my future.Support the showTo support the show, CLICK HEREYou can follow me on Instagram: @elliot.t.waters

In today's episode, we're going to talk about a substance that has been around for centuries but is currently gaining some attention in the health and wellness community: methylene blue. You might have heard of it as a chemical used in labs or even in aquariums as a disinfectant or anti-fungal, but what is it actually? We'll break it all down, talk about its potential benefits, and explore the side effects. We'll also get into why some people respond to methylene blue and others don't. So, let's jump right in! What is Methylene Blue? So, first things first, what exactly is methylene blue? Well, it's a synthetic dye that was first created back in the late 1800s. It was first synthesized in 1876 by a German chemist named Heinrich Caro. It was initially used as a dye for fabrics, but it didn't take long for scientists to realize that it had some remarkable medicinal properties. One of the first medical uses of methylene blue was as a treatment for malaria. In fact, it was the first synthetic drug used to treat the disease. Malaria, caused by a parasite spread by mosquitoes, was a major health crisis, particularly in tropical regions. Methylene blue was used as an antimalarial treatment because of its ability to interfere with the parasite's life cycle. In addition to treating malaria, methylene blue was also used as a diagnostic tool. It was used in medical imaging and as a staining agent in laboratories. Its bright blue color made it easy to see in different biological samples, which helped researchers track the progress of diseases and study cellular structures. Later, in the 20th century, methylene blue found other uses in medicine, such as in the treatment of methemoglobinemia, a condition where the blood can't effectively carry oxygen. It was found to be effective in treating this condition by helping to restore the blood's ability to carry oxygen. How Does Methylene Blue Work? Methylene blue boosts mitochondrial function by enhancing cytochrome c oxidase, a key enzyme involved in energy production. This helps cells produce more ATP, increasing overall energy and vitality. Additionally, it affects nitric oxide (NO) levels in the body, influencing blood vessel dilation and oxygen delivery. Let's talk a little science here.  Because methylene blue can inhibit nitric oxide synthase (NOS), particularly endothelial NOS (eNOS), it may reduce nitric oxide production and cause vasoconstriction (narrowing of blood vessels). While this may help manage conditions like sepsis or shock, it can also limit nitric oxide's vasodilatory benefits. The compound also supports nitric oxide recycling by enhancing mitochondrial function, indirectly benefiting blood flow and oxygen delivery. The Potential Benefits of Methylene Blue So, what are the potential benefits of methylene blue? Well, let's break them down. Cognitive Function: One of the most exciting areas of research is methylene blue's potential to improve cognitive function. Some studies suggest that it can enhance memory, focus, and even slow down the progression of neurodegenerative diseases like Alzheimer's. Its ability to improve mitochondrial function means your brain cells could be getting more energy, which could lead to better cognitive performance. Anti-Aging: As we mentioned earlier, its antioxidant properties can help protect cells from oxidative stress, which plays a big role in the aging process. By mitigating this stress, methylene blue may have anti-aging effects on both the brain and the body. Mental Clarity and Mood: Some users report improvements in mood and mental clarity after using methylene blue. This could be linked to its effects on mitochondrial health and energy production, but there's still much more research to be done. Cellular Health and Longevity: Beyond just improving cognitive function, methylene blue is also being studied for its broader impact on overall cellular health. The idea is that by improving mitochondrial function and reducing oxidative stress, it could help to slow down the aging of all types of cells in your body, potentially promoting longevity. So, yeah, sounds pretty cool, right? But, like anything, it's not all sunshine and rainbows. Let's talk about some potential side effects and who may not respond well to methylene blue. The Side Effects of Methylene Blue and Why Some Don't Respond to Methylene Blue As promising as methylene blue sounds, there are some side effects that come with it. For one, high doses of methylene blue can be toxic, so it's important to be cautious with its use. Some people may experience symptoms like nausea, dizziness, or headaches. Additionally, it can cause skin discoloration—yep, your skin might turn a bit blue, though it's temporary. Now, one of the more interesting things about methylene blue is that not everyone responds to it the same way. Some people see significant benefits, while others might not feel much of anything. There are a few reasons for this. First, individual genetics can play a big role. People have different levels of mitochondrial efficiency and varying abilities to process certain compounds, which means that some might not experience the same boost in energy or mental clarity that others do. Secondly, the dosage matters. Methylene blue has a pretty narrow therapeutic window, meaning too little might not have much effect, and too much can lead to toxicity. Finding the right dose is key, and that's where a healthcare provider or a practitioner familiar with it comes in handy. Lastly, if someone has certain conditions, like serotonin syndrome or G6PD deficiency, they should avoid methylene blue, as it can exacerbate those conditions. For example, methylene blue can increase serotonin levels, which could lead to serotonin syndrome in some individuals, a potentially life-threatening condition. What About Methylene Blue Dosing High doses of methylene blue can affect several systems in the body and potentially lead to significant side effects or toxicity. Here's an overview of the areas where high doses can have an impact: 1. Kidneys Renal toxicity: High doses of methylene blue may cause oxidative stress in kidney cells, leading to kidney damage or acute kidney injury (AKI), especially in individuals with pre-existing kidney issues. Hemolysis risk: Methylene blue, particularly at higher doses, can cause hemolysis (destruction of red blood cells), leading to the release of hemoglobin, which can overwhelm the kidneys and cause kidney damage. 2. Central Nervous System Confusion and agitation: Large doses of methylene blue can cause neurotoxicity, leading to symptoms like confusion, agitation, and even delirium. Headaches: A common side effect at higher doses, possibly due to its effects on blood flow and serotonin levels. Seizures: There is a risk of seizures at high doses, especially if the person is already predisposed to neurological issues or is combining methylene blue with other medications that affect the central nervous system. 3. Cardiovascular System Hypertension (High Blood Pressure): Methylene blue can potentially increase blood pressure due to its ability to inhibit nitric oxide production, leading to vasoconstriction (narrowing of blood vessels). This is more pronounced at higher doses. Arrhythmias: High doses may also lead to heart arrhythmias (irregular heartbeats) due to its influence on vascular tone and nitric oxide pathways. 4. Serotonin Levels Serotonin Syndrome: High doses of methylene blue can elevate serotonin levels in the brain. This could potentially lead to serotonin syndrome, a life-threatening condition characterized by symptoms such as agitation, high body temperature, rapid heart rate, and muscle rigidity. This is especially a concern if methylene blue is combined with other serotonergic drugs, like SSRIs, SNRIs, or MAO inhibitors. 5. Gastrointestinal System Nausea and vomiting: High doses of methylene blue can irritate the stomach and cause gastrointestinal discomfort, including nausea, vomiting, and abdominal pain. Diarrhea: Some people may also experience diarrhea as a side effect of higher doses. 6. Skin and Mucous Membranes Discoloration: Methylene blue is known to stain skin and mucous membranes. High doses can cause blue discoloration of the skin, tongue, and urine, though this is not harmful and is usually temporary. 7. Liver Liver toxicity: There is some evidence that high doses of methylene blue might place extra strain on the liver, as it is metabolized by the liver. In extreme cases, this could lead to hepatotoxicity (liver damage), though this is rare and more likely with prolonged use. Where Can I Buy Methylene Blue? Alright, so when you're buying methylene blue, it's super important to get it from a trusted source. Why? Because if you're getting a product that's low quality, it could have impurities or the wrong concentration, and that totally messes with the health benefits. Methylene blue is used in everything from research to nootropics, and its effectiveness really depends on how pure and potent it is.  That's why you want to go with a reputable retailer—like MitoZen, which Chase Hughes actually mentioned on Joe Rogan's podcast. They've got strict standards for quality, so you can trust you're getting the real deal, the right dosage, and none of those unwanted side effects from shady products. Thanks for listening to The Peptide Podcast. If you found this episode helpful, be sure to subscribe and leave a review. And as always, have a happy, healthy week.

In this episode we look at pharmacological treatments frequently used for children, particularly neurodivergent children. We discuss the evidence, the pros, the cons, the side effects and the stigma associated with medication for children.References cited:Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2022). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & therapeutics, 230, 107940.Boland, H., DiSalvo, M., Fried, R., Woodworth, K. Y., Wilens, T., Faraone, S. V., & Biederman, J. (2020). A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. Journal of Psychiatric Research, 123, 21-30.https://doi.org/10.1016/j.jpsychires.2020.01.006Garland, E. J., Kutcher, S., Virani, A., & Elbe, D. (2016). Update on the use of SSRIs and SNRIs with children and adolescents in clinical practice. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 25(1), 4.Hetrick, S. E., McKenzie, J. E., & Merry, S. N. (2010). The use of SSRIs in children and adolescents. Current Opinion in Psychiatry, 23(1), 53-57.Catalá-López, F., Hutton, B., Núñez-Beltrán, A., Page, M. J., Ridao, M., Macías Saint-Gerons, D., ... & Moher, D. (2017). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: a systematic review with network meta-analyses of randomised trials. PloS one, 12(7), e0180355.Dalsgaard, S., Nielsen, H. S., & Simonsen, M. (2014). Consequences of ADHD medication use for children's outcomes. Journal of health economics, 37, 137-151. https://doi.org/10.1016/j.jhealeco.2014.05.005

On this Real Life Pharmacology Podcast episode, we cover medications 181-185. Proscar is the brand name for finasteride. This medication can be helpful in shrinking the size of the prostate but it does typically take a while to work (months). Sinemet is a combination of carbidopa and levodopa. Levodopa is converted in the central nervous system to dopamine to help alleviate a shortage of dopamine in the brain. Risedronate is a bisphosphonate medication that can be used in the treatment of osteoporosis. Albuterol (Ventolin) is a short-acting beta-agonist that is used to relieve symptoms of acute respiratory distress most often associated with an asthma exacerbation. Tramadol is classified as an opioid analgesic. It also has activity similar to SNRIs as it has the ability to increase serotonin and norepinephrine in the brain.

This episode launches the first part of a 3-part mini-series on IBS-C, shedding light on the complexities of this widespread condition that affects millions of people across the U.S. It stresses the importance of a holistic, patient-centered approach to managing IBS-C. We explore the various medications used to treat IBS-C, including both over-the-counter options and prescription drugs, offering a comprehensive review. Our expert guest, Dr. Justin Brandler, a neurogastroenterologist at Virginia Mason Franciscan Health, provides valuable insights into the mechanisms and effectiveness of these treatments.Dr. Brandler simplifies the intricate science and treatment of IBS into easy-to-understand concepts. He likens his role in treating IBS to that of both a plumber and an electrician. As a disorder of gut-brain interaction (DGBI), IBS affects how the brain and spinal cord process signals, influencing gastrointestinal symptoms.Different patients respond to different treatment approaches. Dr. Brandler discusses medications that target the "plumbing" aspect of IBS, including pharmaceutical options like linaclotide, tenapanor, and lubiprostone, as well as over-the-counter treatments such as magnesium oxide, senna, and bisacodyl. He also covers treatments that address the altered brain-gut connection in IBS, highlighting various neuromodulators, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), and their role in adjusting the nervous system to help alleviate IBS symptoms.We explore essential tips for making the most of your medical appointments, such as organizing a concise summary of your medical history and symptoms to ensure clear and effective communication, including outlining your goals. Preparing ahead of time can help your healthcare providers deliver the best possible care and make the right referrals for your needs.This podcast was sponsored by Ardelyx.Resources: Living your BEST IBS Life: Practical Tools to Beat the Battle with your Bowels by Justin Brandler, MD via IFFGDMechanisms of Action Considerations in the Management of IBS-CLearn more about Kate and Dr. Riehl:Website: www.katescarlata.com and www.drriehl.comInstagram: @katescarlata @drriehl and @theguthealthpodcastOrder Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS. The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Send us a textWhat if we told you that understanding the science behind depression treatment could change the way you approach mental health? Join us as we unravel the complexities of neurotransmitters and mood disorders, exploring both historical insights and modern-day treatments. From Joseph Schildkraut's catecholamine hypothesis to the permissive hypothesis by Arthur Prang and Alec Coppen, we cover the intriguing developments in understanding chemical imbalances. We discuss the vital role of antidepressants like SNRIs and SSRIs and tackle the challenges posed by age-related changes in the brain. With a deep dive into these scientific concepts, you'll gain a clearer picture of how medication manages neurotransmitter levels and why it's just one piece of the puzzle.But medication isn't the complete answer to mental health. In our conversation, we emphasize the need for a holistic approach, where therapy, personal effort, and lifestyle changes are paramount to healing. Learn how self-care practices, such as massage therapy and chiropractic care, can significantly enhance mental well-being. And don't miss the heartwarming story of Paul Myers and Brian Harris—a powerful testament to human connection and the support systems essential for recovery. Stay tuned for our exciting holiday special announcement, promising an episode full of fun and spontaneity!FIND ME:My Website: https://motorcityhypnotist.com/podcastMy social media links: Facebook: https://www.facebook.com/motorcityhypnotist/YouTube: https://www.youtube.com/channel/UCCjjLNcNvSYzfeX0uHqe3gATwitter: https://twitter.com/motorcityhypnoInstagram: motorcityhypnoFREE HYPNOSIS GUIDEhttps://detroithypnotist.convertri.com/podcast-free-hypnosis-guidePlease also subscribe to the show and leave a review.(Stay with me as later in the podcast, I'll be giving away a free gift to all listeners!)Change your thinking, change your life!Laugh hard, run fast, be kind. David R. Wright MA, LPC, CHTThe Motor City Hypnotist

Depression is one of the most researched mood disorders, but if we look a bit deeper into how depression is able to develop, it is more nuanced than we think. This means, treating depression isn't a one size fits all solution. It is agreed upon that depression is a chemical imbalance and can be treated with SSRIs or SNRIs, etc., which can work for some, but this doesn't always work for everyone. Understanding what happens in the body and brain when it comes to nervous system outputs and how we are wired, as well as our connection to nature and sunlight, we can start to understand the complexities of depression, and find ways to treat it at an individual level. In today's episode, Elisabeth and Jennifer are joined by Matt Bush to talk about depression, chronic fatigue and functional freeze, and how they are all interlinked with one another. They discuss myths about depression and how pharmaceuticals aren't the only, or best, way to treat depression. Also, how we may become wired toward depression at a young age by witnessing and mimicking caregivers in their own depressive states and how social connection, nature, and neurodrills that produce domaine, can help rewire the brain. Depression can look and feel insidious, but its main function is to be protective. If we reframe the way we look at depression, we can be effective in healing it.  Join us to learn about this and more! Topics discussed in this episode:   Different levels of freeze responses The overlap of functional freeze and burnout Chronic fatigue as a protective output What is depression? Some myths about depression Are pharmaceuticals necessary to treat depression? How depression can be wired into us by mimicking our primary caregivers Social connection as a way to rewire depression Dopamine's role in the correlation between addiction and depression How neurodrills can rewire and change brain chemistry Nature as a healing tool The socioeconomic and cultural impact on the nervous system   Learn more about the Neuro-Somatic Intelligence Coaching program and sign up for the spring cohort now! https://www.neurosomaticintelligence.com   Get started training your nervous system with our FREE 2-week offer on the Brain Based Membership site: https://www.rewiretrial.com   Connect with us on social media: @trauma.rewired   Join the Trauma Rewired Facebook Group! https://www.facebook.com/groups/761101225132846   FREE 1 Year Supply of Vitamin D + 5 Travel Packs from Athletic Greens when you use my exclusive offer: https://www.drinkag1.com/rewired   This episode was produced by Podcast Boutique https://www.podcastboutique.com Trauma Rewired podcast  is intended to educate and inform but does not constitute medical, psychological or other professional advice or services. Always consult a qualified medical professional about your specific circumstances before making any decisions based on what you hear.  We share our experiences, explore trauma, physical reactions, mental health and disease. If you become distressed by our content, please stop listening and seek professional support when needed. Do not continue to listen if the conversations are having a negative impact on your health and well-being.  If you or someone you know is struggling with their mental health, or in mental health crisis and you are in the United States you can 988 Suicide and Crisis Lifeline.  If someone's life is in danger, immediately call 911.  We do our best to stay current in research, but older episodes are always available.  We don't warrant or guarantee that this podcast contains complete, accurate or up-to-date information. It's very important to talk to a medical professional about your individual needs, as we aren't responsible for any actions you take based on the information you hear in this podcast. We  invite guests onto the podcast. Please note that we don't verify the accuracy of their statements. Our organization does not endorse third-party content and the views of our guests do not necessarily represent the views of our organization. We talk about general neuro-science and nervous system health, but you are unique. These are conversations for a wide audience. They are general recommendations and you are always advised to seek personal care for your unique outputs, trauma and needs.  We are not doctors or licensed medical professionals. We are certified neuro-somatic practitioners and nervous system health/embodiment coaches. We are not your doctor or medical professional and do not know you and your unique nervous system. This podcast is not a replacement for working with a professional. The BrainBased.com site and Rewiretrail.com is a membership site for general nervous system health, somatic processing and stress processing. It is not a substitute for medical care or the appropriate solution for anyone in mental health crisis.  Any examples mentioned in this podcast are for illustration purposes only. If they are based on real events, names have been changed to protect the identities of those involved.  We've done our best to ensure our podcast respects the intellectual property rights of others, however if you have an issue with our content, please let us know by emailing us at traumarewired@gmail.com  All rights in our content are reserved

Learn the skills to regulate your emotions, join the membership: https://courses.therapyinanutshell.com/membership Morning depression is a common experience where symptoms of depression, such as fatigue, hopelessness, brain fog, and difficulty getting out of bed, are at their worst upon waking. This is largely influenced by biological factors, including the cortisol awakening response, where stress hormones spike in the morning, causing a sense of overwhelm or shutdown. Misalignment of the circadian rhythm, due to genetics, sleep disorders, or inconsistent schedules, can exacerbate these symptoms. Additional contributors include inflammation, which peaks for some people in the morning, and underlying conditions like sleep deprivation, insomnia, or physical illnesses such as low thyroid function or anemia. Treatment focuses on resetting the circadian rhythm and managing cortisol through light therapy, melatonin microdosing, consistent sleep hygiene, and gradually building a positive morning routine. Simple actions like taking one step out of bed, drinking water, or practicing gratitude can help counteract the depressive freeze response. Talk therapy and medication, particularly SNRIs, can also provide significant relief. By addressing these biological and behavioral factors, individuals can create mornings that feel manageable and even uplifting. Small changes, taken one step at a time, can lead to meaningful improvements. Check out the transcript: https://therapyinanutshell.com/morning-depression/ Looking for affordable online counseling? My sponsor, BetterHelp, connects you to a licensed professional from the comfort of your own home. Try it now for 10% off your first month: https://betterhelp.com/therapyinanutshell Learn more in one of my in-depth mental health courses: https://courses.therapyinanutshell.com Support my mission on Patreon: https://www.patreon.com/therapyinanutshell Sign up for my newsletter: https://www.therapyinanutshell.com Check out my favorite self-help books: https://kit.co/TherapyinaNutshell/best-self-help-books  Therapy in a Nutshell and the information provided by Emma McAdam are solely intended for informational and entertainment purposes and are not a substitute for advice, diagnosis, or treatment regarding medical or mental health conditions. Although Emma McAdam is a licensed marriage and family therapist, the views expressed on this site or any related content should not be taken for medical or psychiatric advice. Always consult your physician before making any decisions related to your physical or mental health. In therapy I use a combination of Acceptance and Commitment Therapy, Systems Theory, positive psychology, and a bio-psycho-social approach to treating mental illness and other challenges we all face in life. The ideas from my videos are frequently adapted from multiple sources. Many of them come from Acceptance and Commitment Therapy, especially the work of Steven Hayes, Jason Luoma, and Russ Harris. The sections on stress and the mind-body connection derive from the work of Stephen Porges (the Polyvagal theory), Peter Levine (Somatic Experiencing) Francine Shapiro (EMDR), and Bessel Van Der Kolk. I also rely heavily on the work of the Arbinger Institute for my overall understanding of our ability to choose our life's direction. And deeper than all of that, the Gospel of Jesus Christ orients my personal worldview and sense of security, peace, hope, and love https://www.churchofjesuschrist.org/comeuntochrist/believe If you are in crisis, please contact the National Suicide Prevention Hotline at https://suicidepreventionlifeline.org or 1-800-273-TALK (8255) or your local emergency services. Copyright Therapy in a Nutshell, LLC

An alarming number of individuals find themselves dependent on antidepressants and psychiatric medications, desperately seeking guidance on how to safely discontinue their use. The general medical community has failed to assist people in safely getting off these drugs. The dependency can create severe withdrawal symptoms. Most doctors have no clue how to get their patients off safely keeping them in a cycle of drug dependency. The worst of prescribers will frame the withdrawal symptoms as worsening "depression" and justification for staying on drugs. On Episode 154 of the Radically Genuine Podcast Dr. Roger McFillin dives into the topic of deprescribing and tapering off psychiatric drugs with a pharmacist. Dr. Shawn Gill, PharmD, is a pharmacist, writer, podcaster, and entrepreneur dedicated to sparking change in healthcare through deprescribing. He is the founder of Deprescribe Solutions, an independent consulting practice focused on reversing early-stage chronic conditions in mental health, hypertension, and type 2 diabetes. He hosts the "Deprescribe" podcast and writes the Substack newsletter "B.U.D.S," where he explores topics in health, deprescribing, parenting, and personal growth. Chapters00:00 The Silent Epidemic of Over-Prescription03:06 The Role of Pharmacists in Mental Health06:11 Understanding Compounding Pharmacy09:01 Polypharmacy: A Growing Concern11:58 The Dangers of SSRIs and SNRIs15:12 The Ethics of Prescribing Practices18:01 Navigating Withdrawal and Tapering20:57 Hyperbolic vs. Linear Tapering24:14 Protracted Withdrawal: Understanding the Risks26:49 Preventing Dependency: Education and Awareness29:58 The Future of Mental Health TreatmentResources: Systematic review detailing the relationship between SERT occupancy and SSRI dosing.- This is a great systematic review that breaks down the hyperbolic nature of SSRIs. It also elucidates on the potential pharmacology and mechanism behind protracted withdrawal, which we touched upon. RELEASE Clinical Trial - RCT which will be investigating hyperbolic tapering vs. linear tapering. The trial will begin in 2025.Outro Health - Fantastic organization trying to scale and make hyperbolic tapering accessible to the US. Dr. Sean Gill SubstackDeprescribe Podcast w/ Dr. Sean Gill RADICALLY GENUINE PODCASTDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / XSubstack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically GenuineConscious Clinician CollectivePLEASE SUPPORT OUR PARTNERS15% Off Pure Spectrum CBD (Code: RadicallyGenuine)10% off Lovetuner click here—-----------FREE DOWNLOAD! DISTRESS TOLERANCE SKILLS

Can stress rewire your brain and alter your body's health? Join us on this gripping episode of Kore Kast as we uncover the deep-seated effects of trauma on our brains and bodies. You'll discover how traumatic experiences can trigger your body's stress response, affecting crucial regions like the amygdala, hippocampus, and prefrontal cortex. These changes can disrupt your emotional regulation, memory, and decision-making abilities. We'll also highlight how imbalances in key neurotransmitters such as serotonin and dopamine can pave the way for mental health challenges like depression and anxiety. Beyond the mental sphere, trauma has tangible physical repercussions, manifesting as chronic pain, fatigue, and gastrointestinal issues, while also compromising your immune system and heightening vulnerability to illnesses and autoimmune diseases. In the next segment, we turn our focus to hope and healing, exploring effective treatments for PTSD. Learn about groundbreaking psychotherapies, including cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and narrative exposure therapy, which empower individuals to process trauma and build resilient coping mechanisms. Additionally, we'll discuss how medications like SSRIs and SNRIs can aid in managing anxiety and depression. You'll hear about the transformative power of lifestyle changes such as regular exercise, mindfulness practices, and social support in promoting emotional well-being. Discover how physical activity can release endorphins, enhance cognitive function, improve sleep, and foster a sense of accomplishment and community. Tune in for a comprehensive guide on navigating the path to recovery and reclaiming your life from the grips of trauma.Support the Show.https://www.kore-fit.comhttps://www.korecandlecompany.com

Depression is one of the most researched mood disorders, but if we look a bit deeper into how depression is able to develop, it is more nuanced than we think. This means, treating depression isn't a one size fits all solution. It is agreed upon that depression is a chemical imbalance and can be treated with SSRIs or SNRIs, etc., which can work for some, but this doesn't always work for everyone. Understanding what happens in the body and brain when it comes to nervous system outputs and how we are wired, as well as our connection to nature and sunlight, we can start to understand the complexities of depression, and find ways to treat it at an individual level. In today's episode, Elisabeth and Jennifer are joined by Matt Bush to talk about depression, chronic fatigue and functional freeze, and how they are all interlinked with one another. They discuss myths about depression and how pharmaceuticals aren't the only, or best, way to treat depression. Also, how we may become wired toward depression at a young age by witnessing and mimicking caregivers in their own depressive states and how social connection, nature, and neurodrills that produce domaine, can help rewire the brain. Depression can look and feel insidious, but its main function is to be protective. If we reframe the way we look at depression, we can be effective in healing it.  Join us to learn about this and more! Topics discussed in this episode:   Different levels of freeze responses The overlap of functional freeze and burnout Chronic fatigue as a protective output What is depression? Some myths about depression Are pharmaceuticals necessary to treat depression? How depression can be wired into us by mimicking our primary caregivers Social connection as a way to rewire depression Dopamine's role in the correlation between addiction and depression How neurodrills can rewire and change brain chemistry Nature as a healing tool The socioeconomic and cultural impact on the nervous system   Learn more about the Neuro-Somatic Intelligence Coaching program and sign up for the spring cohort now! https://www.neurosomaticintelligence.com   Get started training your nervous system with our FREE 2-week offer on the Brain Based Membership site: https://www.rewiretrial.com   Join the Next Level Neuro Mentorship Program: https://www.nextlevelneuro.com/a/2147666262/2U4AvzLR   REWIRE RETREAT  https://www.thenatureofmindbody.com/book-online   Contact us about private Rewire Neuro-Somatic Coaching: https://brainbased-wellness.com/rewire-private-neuro-somatic-coaching/   Connect with us on social media: @trauma.rewired   Join the Trauma Rewired Facebook Group! https://www.facebook.com/groups/761101225132846   FREE 1 Year Supply of Vitamin D + 5 Travel Packs from Athletic Greens when you use my exclusive offer: https://www.drinkag1.com/rewired   This episode was produced by Podcast Boutique https://www.podcastboutique.com Trauma Rewired podcast  is intended to educate and inform but does not constitute medical, psychological or other professional advice or services. Always consult a qualified medical professional about your specific circumstances before making any decisions based on what you hear.  We share our experiences, explore trauma, physical reactions, mental health and disease. If you become distressed by our content, please stop listening and seek professional support when needed. Do not continue to listen if the conversations are having a negative impact on your health and well-being.  If you or someone you know is struggling with their mental health, or in mental health crisis and you are in the United States you can 988 Suicide and Crisis Lifeline.  If someone's life is in danger, immediately call 911.  We do our best to stay current in research, but older episodes are always available.  We don't warrant or guarantee that this podcast contains complete, accurate or up-to-date information. It's very important to talk to a medical professional about your individual needs, as we aren't responsible for any actions you take based on the information you hear in this podcast. We  invite guests onto the podcast. Please note that we don't verify the accuracy of their statements. Our organization does not endorse third-party content and the views of our guests do not necessarily represent the views of our organization. We talk about general neuro-science and nervous system health, but you are unique. These are conversations for a wide audience. They are general recommendations and you are always advised to seek personal care for your unique outputs, trauma and needs.  We are not doctors or licensed medical professionals. We are certified neuro-somatic practitioners and nervous system health/embodiment coaches. We are not your doctor or medical professional and do not know you and your unique nervous system. This podcast is not a replacement for working with a professional. The BrainBased.com site and Rewiretrail.com is a membership site for general nervous system health, somatic processing and stress processing. It is not a substitute for medical care or the appropriate solution for anyone in mental health crisis.  Any examples mentioned in this podcast are for illustration purposes only. If they are based on real events, names have been changed to protect the identities of those involved.  We've done our best to ensure our podcast respects the intellectual property rights of others, however if you have an issue with our content, please let us know by emailing us at traumarewired@gmail.com  All rights in our content are reserved  

Title: 110 | Postpartum Anxiety Treatments Part 2  Welcome to the New Mom Naturopath Podcast! Today's episode dives deep into the often-overlooked challenges of postpartum anxiety. Many new moms experience a range of symptoms from rapid heartbeat and nausea to irritability and intrusive thoughts. Understanding these signs and knowing when to seek help is crucial for your health and well-being. Coaching with me:  Feeling like this podcast series was just enough to get you above water? Still feeling overwhelmed. Like there is too much to do. You are losing patience with your baby. FInding it hard to enjoy this time without a little one. Perhaps you feel you have lost touch with who you were pre-pregnancy with? I can help you manage the stress of becoming a mom. That is what my coaching program is all about: Finding who you are again in the chaos of postpartum. Hurry up prices are going up soon!  Click here to schedule a 30-minute call with me!   Today we are expanding on Monday Episode, and we are talking about:   Medication Options: Discuss the role of medications like SSRIs and SNRIs in managing postpartum anxiety, their effects, and what to expect when starting them. Supplements and Herbs: Examine the potential benefits of using supplements like lavender and fish oil to support mental health during the postpartum period. What we Covered in Monday's Episode: Click here to Listen to it!  Symptoms of Postpartum Anxiety: Explore the emotional and physical symptoms that can impact new moms, from constant worry and panic to difficulty concentrating and a lack of connection with the baby. Risk Factors: Understand the factors that increase the likelihood of experiencing postpartum anxiety, including personal and family history, previous losses, and the stresses of caring for multiple children. Non-Medication Based Treatments: Discover the benefits of counseling, where you can learn coping skills, improve communication, and focus on self-care. We'll discuss what to expect in therapy sessions and how to differentiate normal stress from anxiety. Self-Care Treatments: Learn grounding exercises and the importance of nutrition, sun exposure, and maintaining social connections. Practical tips for self-care routines will also be shared   Coaching with me:  Feeling like this podcast series was just enough to get you above water? Still feeling overwhelmed. Like there is too much to do. You are losing patience with your baby. FInding it hard to enjoy this time without a little one. Perhaps you feel you have lost touch with who you were pre-pregnancy with? I can help you manage the stress of becoming a mom. That is what my coaching program is all about: Finding who you are again in the chaos of postpartum. Hurry up prices are going up soon!  Click here to schedule a 30-minute call with me!     How to Connect with me:  Here is the link to the facebook group: https://www.facebook.com/groups/newmomnaturopath  Link to coaching call: Click here to schedule a 30-minute call with me!   Link to my instagram page: https://www.instagram.com/drkailyngalloway/ My resources Page: New Mom Naturopath Resource Page  

Show Notes:  Title: 109 | Treatments for Postpartum Anxiety - Part 1  Welcome to the New Mom Naturopath Podcast! Today's episode dives deep into the often-overlooked challenges of postpartum anxiety. Many new moms experience a range of symptoms from rapid heartbeat and nausea to irritability and intrusive thoughts. Understanding these signs and knowing when to seek help is crucial for your health and well-being. What We'll Cover: Symptoms of Postpartum Anxiety: Explore the emotional and physical symptoms that can impact new moms, from constant worry and panic to difficulty concentrating and a lack of connection with the baby. Risk Factors: Understand the factors that increase the likelihood of experiencing postpartum anxiety, including personal and family history, previous losses, and the stresses of caring for multiple children. Non-Medication Based Treatments: Discover the benefits of counseling, where you can learn coping skills, improve communication, and focus on self-care. We'll discuss what to expect in therapy sessions and how to differentiate normal stress from anxiety. Self-Care Treatments: Learn grounding exercises and the importance of nutrition, sun exposure, and maintaining social connections. Practical tips for self-care routines will also be shared. Come back to Thursdays episode where we will talk about:  Medication Options: Discuss the role of medications like SSRIs and SNRIs in managing postpartum anxiety, their effects, and what to expect when starting them. Supplements and Herbs: Examine the potential benefits of using supplements like lavender and fish oil to support mental health during the postpartum period. Call to Action: Subscribe for more insights: Stay connected with us for more valuable discussions on navigating motherhood. Share your thoughts: We love hearing from you! Please leave a review for us, I want to hear your feedback so I can improve the show and make it more of what you need.  Join our community: Check out our social media or visit our website for additional resources and support.Here is the link to the facebook group: https://www.facebook.com/groups/newmomnaturopath  Coaching with me:  Feeling like this podcast series was just enough to get you above water? Still feeling overwhelmed. Like there is too much to do. You are losing patience with your baby. FInding it hard to enjoy this time without a little one. Perhaps you feel you have lost touch with who you were pre-pregnancy with? I can help you manage the stress of becoming a mom. That is what my coaching program is all about: Finding who you are again in the chaos of postpartum. Hurry up prices are going up soon!  Click here to schedule a 30-minute call with me!     How to Connect with me:  Here is the link to the facebook group: https://www.facebook.com/groups/newmomnaturopath  Link to coaching call: Click here to schedule a 30-minute call with me!   Link to my instagram page: https://www.instagram.com/drkailyngalloway/ My resources Page: New Mom Naturopath Resource Page

In this episode, Dr. Rena Malik, MD delves into the complex and often misunderstood topic of menopause. She explains the different stages: premenopause, perimenopause, menopause, and postmenopause, highlighting the range of symptoms women may experience, from hot flashes and mood swings to sleep disturbances and genitourinary issues. Dr. Malik discusses how these symptoms arise due to declining estrogen levels and provides detailed information on various treatment options, including hormonal replacement therapies and non-hormonal alternatives. Listeners will gain a comprehensive understanding of menopause, its impact on different aspects of health, and the available strategies to manage symptoms and improve quality of life. Additionally, Dr. Malik emphasizes the importance of individualized treatment plans, noting the various forms of estrogen administration, such as transdermal gels, oral tablets, and vaginal rings, each with its own benefits and considerations. She also addresses the risks and benefits associated with hormone therapy, citing the outcomes of notable studies like the Women's Health Initiative. For women who cannot or prefer not to use hormone therapy, Dr. Malik discusses alternative treatments, including SSRIs, SNRIs, and other medications. By demystifying menopause and its treatments, this episode empowers women to make informed decisions about their health during this significant life transition. ▶️Chapters: 00:00 Menopause 03:44 Menopausal symptoms and treatment 09:46 Hormone therapy benefits and risks in women 10:49 Benefits of Progesterone Let's Connect!: WEBSITE: http://www.renamalikmd.com YOUTUBE: https://www.youtube.com/@RenaMalikMD INSTAGRAM: http://www.instagram.com/RenaMalikMD TWITTER: http://twitter.com/RenaMalikMD FACEBOOK: https://www.facebook.com/RenaMalikMD/ LINKEDIN: https://www.linkedin.com/in/renadmalik PINTEREST: https://www.pinterest.com/renamalikmd/ TIKTOK: https://www.tiktok.com/RenaMalikMD ------------------------------------------------------ DISCLAIMER: This podcast is purely educational and does not constitute medical advice. The content of this podcast is my personal opinion, and not that of my employer(s). Use of this information is at your own risk. Rena Malik, M.D. will not assume any liability for any direct or indirect losses or damages that may result from the use of information contained in this podcast including but not limited to economic loss, injury, illness or death. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, friends! In today's episode, we tackle two profound listener questions that may resonate with many of you: How Do You Feel About Antidepressants and Anti-Anxiety Medications? A listener asks about the use of antidepressants and anti-anxiety medications, expressing concerns about addiction and the potential difficulty of getting off these meds. Dr. Duff shares his positive personal experience with Lexapro, explaining the various classes of medications, including SSRIs, SNRIs, and benzodiazepines. He emphasizes the importance of evaluating both the benefits and potential side effects of these medications, as well as considering the cost of not using them. Dr. Duff also addresses misconceptions about feeling disconnected from reality due to medication and discusses the concept of psychological and physiological dependence. Dealing with a Hurtful Partner: Another listener seeks advice on how to help their partner understand the impact of their hurtful behavior, which includes yelling and mocking. Dr. Duff offers empathetic support, acknowledging the listener's heartbreak. He outlines the importance of healthy conflict resolution, setting personal boundaries, and recognizing signs of potential abuse. Dr. Duff encourages open communication and suggests resources for improving relationship dynamics, while also addressing the need for safety and support when dealing with ongoing hurtful behavior. As always, you can send me questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode403

Episode 171: Postpartum Blues, Depression, and PsychosisFuture Dr. Nguyen defines and explains the difference between baby blues, depression, and psychosis. Dr. Arreaza added comments about screening and management of these conditions. Written by Vy Nguyen, OMSIII, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments 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.Introduction.Pregnancy is one of the most well-celebrated milestones in one's life. However, once the baby is born, the focus of the family and society quickly shifts to the new member. It is important to continue to care for our mothers and offer them support physically and mentally as they begin their transition into their role. Peripartum mood disorders affect both new and experienced mothers as they navigate through the challenges of motherhood. The challenges of motherhood are not easy to spot, and they include sleep deprivation, physical exhaustion, dealing with pain, social isolation, and financial pressures, among other challenges. Let's focus on 3 aspects of the postpartum period: Postpartum Blues (PPB), Post-partum Depression (PPD) and Post-partum Psychosis (PPP). By the way, we briefly touched on this topic in episode 20, a long time ago. Postpartum blues (PPB) present as transient and self-limiting low mood and mild depressive symptoms that affect more than 50% of women within two or three days of childbirth and resolve within two weeks of onset. Symptoms vary from crying, exhaustion, irritability, anxiety, appetite changes, and decreased sleep or concentration to mood lability. Women are at risk for PPB.Several factors are thought to contribute to the increased risk of postpartum blues including a history of menstrual cycle-related mood changes, mood changes associated with pregnancy, history of major depression, number of lifetime pregnancies, or family history of postpartum depression. Pathogenesis of PPB: While pathogenesis remains unknown, hormonal changes such as a dramatic decrease in estradiol, progesterone, and prolactin have been associated with the development of postpartum blues. In summary, PPB is equivalent to a brief, transient “sad feeling” after the delivery. Peripartum depression (PPD) occurs in 20% of women and is classified as depressive symptoms that appear within six weeks to 1 year after childbirth. Those with baby blues have an increased risk of developing postpartum depression. About 50% of “postpartum” major depressive episodes begin before delivery, thus the term has been updated from “postpartum” to “peripartum” depressive episodes. Some risk factors include adolescent patients, mothers who deliver premature infants, and women living in urban areas. Interestingly, African American and Hispanic mothers are reported to have onset of symptoms within two weeks of delivery instead of six like their Caucasian counterparts. Additional risks include psychological risks such as a personal history of depression, anxiety, premenstrual syndrome, and sexual abuse; obstetric risks such as emergency c-sections and hospitalizations, preterm or low birth infant, and low hemoglobin; social risks such as lack of social support, domestic violence in form of spousal physical/sexual/verbal abuse; lifestyle risks such as smoking, eating sleep patterns and physical activities. Peripartum depression can present with or without psychotic features, which may appear between 1 in 500 or 1 in 1,000 deliveries, more common in primiparous women. Pathogenesis of PPD: Much like postpartum blues, the pathogenesis of postpartum depression is unknown. However, it is known that hormones can interfere with the hypothalamic-pituitary-adrenal axis (HPA) and lactogenic hormones. HPA-releasing hormones increase during pregnancy and remain elevated up to 12 weeks postpartum. The body receptors in postpartum depression are susceptible to the drastic hormonal changes following childbirth which can trigger depressive symptoms. Low levels of oxytocin and prolactin also play a role in postpartum depression causing moms to have trouble with lactation around the onset of symptoms. The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum persons, as well as older adults. Edinburgh Postnatal Depression Scale (EPDS) can be used in postpartum and pregnant persons (Grade B recommendation).Postpartum psychosis (PPP) is a psychiatric emergency that often presents with confusion, paranoia, delusions, disorganized thoughts, and hallucinations. Around 1-2 out of 1,000 new moms experience postpartum psychosis with the onset of symptoms as quickly as several days and as late as six weeks after childbirth. Given the high risk of suicide and harm, individuals with postpartum psychosis require immediate evaluation and treatment. Postpartum psychosis is considered multifactorial, and the single most important risk factor is first pregnancy with family or personal history of bipolar 1 disorder. Other risk factors include a prior history of postpartum psychosis, family history of psychosis, history of schizoaffective disorder or schizophrenia, or discontinuation of psychiatric medications. Studies show that patients with a history of decreased sleep due to manic episodes are twice as likely to have postpartum psychosis at some point in their lives. However, approximately 50% of mothers who experience psychosis for the first time do not have a history of psychiatric disorder or hospitalization. Evaluation.Symptoms of postpartum blues should not meet the criteria for a major depressive episode and should resolve in 2 weeks. The Edinburg Postpartum Depression Scale which is a useful tool for assessing new moms with depressive symptoms. Postpartum depression is diagnosed when the patient presents with at least five depressive symptoms for at least 2 weeks. According to the DSM5, postpartum depression is defined as a major depressive episode with peripartum onset of mood symptoms during pregnancy or in the 4 weeks following delivery. Symptoms for diagnosis include changes in sleep, interest, energy, concentration, appetite, psychomotor retardation or agitation, feeling of guilt or worthlessness, and suicidal ideation or attempt. These symptoms are not associated with a manic or hypomanic episode and can often lead to significant impediments in daily activities. Peripartum-onset mood episodes can present with or without psychotic features. The depression can be so severe that the mother commits infanticide. Infanticide can happen, for example, with command hallucinations or delusions that the infant is possessed.While there are no standard screening criteria in place of postpartum psychosis, questionnaires mentioned earlier such as the Edinburg Postpartum Depression Scale can assess a patient's mood and identify signs of depression and mania. It is important after a thorough history and physical examination to order labs to rule out other medical conditions that can cause depressive and psychotic symptoms. Disorders like electrolyte imbalance, hepatic encephalopathy, thyroid storm, uremia, substance use, infections, and even stroke can mimic a psychiatric disorder. So, How can we treat patients who are diagnosed with a peripartum mood disorder?Management.On the spectrum of peripartum mood disorders, postpartum blues are the least severe and should be self-limiting by week 2. However, patients should be screened for suicidal ideation, paranoia, and homicidal ideation towards the newborn. Physicians should provide validation, education, and resources especially support with sleep and cognitive therapy and/or pharmacotherapy can be recommended if insomnia persists. Regarding postpartum depression, the first-line treatment includes psychotherapy and antidepressants. For those with mild to moderate depression or hesitant to start on medications, psychosocial and psychotherapy alone should be sufficient. However, for those with moderate to severe symptoms, a combination of therapy and antidepressants, such as selective serotonin reuptake inhibitors, is recommended. Once an effective dose is reached, patients should be treated for an additional 6 to 12 months to prevent relapse. In severe cases, patients may need to be hospitalized to treat their symptoms and prevent complications such as self-harm or infanticide.Most SSRIs can be detected in breast milk, but only 10 percent of the maternal level. Thus, they are considered safe during breastfeeding of healthy, full-term infants. So, you mentioned SSRIs, but also SNRIs, bupropion, and mirtazapine are reasonable options for treatment. In patients who have never been treated with antidepressants, zuranolone (a neuroactive steroid) is recommended. Zuranolone is easy to take, works fast, and is well tolerated. Treatment with zuranolone is consistent with practice guidelines from the American College of Obstetricians and Gynecologists.While there are no current guidelines to manage postpartum psychosis, immediate hospitalization is necessary in severe cases. Patients can be started on mood stabilizers such as lithium, valproate, and lamotrigine, and atypical antipsychotics such as quetiapine, and olanzapine, to name a few. Medications like lithium can be eliminated through breast milk and can expose infants to toxicity.The use of medications such as SSRIs, carbamazepine, valproate, and short-acting benzodiazepines are relatively safe and can be considered in those with plans to breastfeed. Ultimately, it is a decision that the patient can make after carefully discussing and weighing the pros and cons of the available medical management. While the prognosis of peripartum mood disorders is relatively good with many patients responding well to treatments, these disorders can have various negative consequences. Individuals with a history of postpartum blues are at increased risk of developing postpartum depression. Similarly, those with a history of postpartum psychosis are at risk of experiencing another episode of psychosis in future pregnancies. Additionally, postpartum depression can have a detrimental effect on mother-infant bonding and affect the growth and development of the infant. These children may have difficulties with social interactions, cognitive development, and depression. In summary, following the birth of a baby can pose new challenges and often is a stressful time for not only the mother but also other family members. Validation and reassurance from primary care physicians in an empathetic and understanding manner may offer support that many mothers may not have in their close social circle. As the first contact, primary care physicians can identify cues and offer support promptly that will not only improve the mental well-being of mothers but also that of the growing children.___________________________Conclusion: Now we conclude episode number 171, “Postpartum blues, depression, and psychosis.” These conditions may be more common than you think. So, be alert during your prenatal and postpartum visits and start management as needed. Psychotherapy and psychosocial therapy alone may be effective but do not hesitate to start antidepressants or antipsychotics when necessary. Make sure you involve the family and the patient in the decision-making process to implement an effective treatment.This week we thank Hector Arreaza and Vy Nguyen. Audio editing 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! _____________________References:Raza, Sehar K. and Raza, Syed. Postpartum Psychosis. National Library of Medicine. Last updated Jun 26, 2023. https://www.ncbi.nlm.nih.gov/books/NBK544304/Balaram, Kripa and Marwaha, Raman. Postpartum Blues. National Library of Medicine. Last updated Mar 6, 2023. https://www.ncbi.nlm.nih.gov/books/NBK554546/Mughal, Saba, Azhar, Yusra, Siddiqui, Waquar. Postpartum Depression. National Library of Medicine. Last updated Oct 7, 2022. https://www.ncbi.nlm.nih.gov/books/NBK519070/Royalty-free music used for this episode: Good Vibes by Simon Pettersson, downloaded on July 20, 2023, from https://www.videvo.net/royalty-free-music/.

In this episode of Quah (Q & A), Sal, Adam & Justin coach four Pump Heads via Zoom. Mind Pump Fit Tip: BUILD MUSCLE to drastically improve your health! (1:45) Risk vs. reward when it comes to kids and contact sports. (15:19) Dispelling misinformation on Sal's tattoo. (19:25) Adam at his lowest weight since competing days. (20:42) Educating the audience on the accuracy of body fat tests. (27:55) The Happy Drops from Organifi are CRUSHING! (32:04) A wedding reception gone TERRIBLY wrong. (36:43) That one-time Justin got stuck on a rollercoaster. (37:47) Adam's embarrassing text. (39:08) Highlighting how we misunderstand studies or data. (43:06) Storytelling and teaching lessons. (46:05) How to get 10 clients in 10 days. (50:40) Shout out to Hippy Feet socks! (51:23) #ListenerLive question #1 – What sort of training/conditioning would you suggest aiding with dance lifts? (57:23) #ListenerLive question #2 – Would you have any suggestions on how to program for 75 Hard to finish strong and not be worn out or injured? (1:09:21) #ListenerLive question #3 – How do I work on body parts that are lagging? (1:24:10) #ListenerLive question #4 – I've had a string of injuries, any advice on how to remedy this? (1:37:52) Related Links/Products Mentioned Ask a question to Mind Pump, live! Email: live@mindpumpmedia.com See and hang out with Mind Pump, LIVE! Saturday, June 15 · 1pm PDT Bellagio Las Vegas. Click the link here for more details. Visit Organifi for the exclusive offer for Mind Pump listeners! **Promo code MINDPUMP at checkout for 20% off. May 10-12th, Mother's Day Weekend - Buy 1 Get 1 Free Organifi Harmony Plus Free Shipping ** Exclusively for Mind Pump Listeners, NCI is offering access to their free guide on learning to find, close and retain 10 clients in 10 days.  May Promotion: MAPS Strong | MAPS Powerlift 50% off! ** Code MAY50 at checkout ** Trends in nutrition, lifestyle, and metabolic disease in the United States from 1900 onwards Effects of macronutrient intake in obesity: a meta-analysis of low-carbohydrate and low-fat diets on markers of the metabolic syndrome Strength Of Grip Declines In Young Adults Mind Pump #1877: Obesity, It's Not Your Genetics Guardian Caps: Are the soft-shelled football helmet covers effective at limiting head injuries? Mind Pump #2320: Throw Away The Scale! An 8-Week Randomized, Double-Blind Trial Comparing Efficacy, Safety, and Tolerability of 3 Vilazodone Dose-Initiation Strategies Following Switch From SSRIs and SNRIs in Major Depressive Disorder The wedding menu that put 80 guests in hospital and left more than 100 people vomiting is revealed - as one attendee says men and women were given different food, but all ended up sick Giving Birth Later in Life Linked to Longer Life | TIME Children's Books by Andy Frisella The Very Hungry Caterpillar book hand2mind Numberblocks Friends One to Five Figures, Toy Figures Collectibles, Small Cartoon Figurines for Kids, Mini Action Figures, Character Figures, Play Figure Playsets, Imaginative Play Toys All Hippy Feet Products - American Made & Eco-Friendly Body Brokers | Rotten Tomatoes California fails to track how billions are spent to fight homelessness Visit Seed for an exclusive offer for Mind Pump listeners! **Promo code 25MINDPUMP at checkout for 25% off your first month's supply of Seed's DS-01® Daily Synbiotic** Improve Your Overhead Press & Build Your Shoulders with Unilateral Kettlebell Carries – Mind Pump TV Chaos Band Training: How To, Benefits, Variations - Muscle & Fitness Using The Earthquake Bar | Westside Barbell Mind Pump #2290: Becoming A Better Man With Jason Khalipa Mind Pump #2220: How To Stay Consistent With Your Workouts Ask Mind Pump Mind Pump #2322: Why Your Butt Won't Grow Mind Pump #1872: Eight Benefits Of Lifting With Light Weight Sore muscles…what does it mean? – Mind Pump Blog Mind Pump #2312: Five Steps To Bounce Back From Overtraining MAPS Prime Pro Webinar Mind Pump Podcast – YouTube Mind Pump Free Resources People Mentioned Drew Canole (@drewcanole) Instagram Mark Hyman, M.D. (@drmarkhyman) Instagram Mike Matthews (@muscleforlifefitness) Instagram Andy Frisella (@andyfrisella) Instagram Joe DeFranco (@defrancosgym)  Instagram James Smith (@smittydiesel)  Instagram Jason Khalipa (@jasonkhalipa) Instagram  

In this episode Dr. Sand leads us on a conversation about how three popular classes of antidepressant medications affect our gastrointestinal tract! SSRIs, TCAs, and SNRIs. This has definitely changed how we view the guts of these patients and may change your mind on how we're using them! Rebecca Sand ND, LAc, MSOM - ⁠⁠https://www.drrebeccasand.com/⁠⁠Ilana Gurevich ND, FABNG, LAc, MSOM - ⁠https://www.openwellnesspdx.com Ami Kapadia, MD, ABFM, ABIHM - ⁠⁠https://www.amikapadia.com/⁠⁠

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠from the Psychiatry section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

Just because your doctor might have advised you that hormone replacement therapy might not be an option for you, this does not mean your doctor won't be able to prescribe you other medications that can help. Here is your summary of non-hormonal prescription options for managing menopause symptoms after cancer treatment which includes a variety of medications such as gabapentin, pregabalin, clonidine, oxybutynin and antidepressants like SSRIs, and SNRIs, which can help alleviate symptoms like hot flushes, mood swings, anxiety, sleep and bladder and vaginal problems. Episode Highlights:00:00 Intro.05:18 Antidepressants can help with menopausal symptoms after cancer.06:58 Antidepressant effectiveness varies; talk to your doctor.11:43 Prescribable non-hormonal vaginal options for comfort.About Dani:The Menopause and Cancer Podcast is hosted by Dani Binnington, menopause guide, patients advocate for people in menopause after a cancer diagnosis, and founder of the online platform Healthy Whole Me. There is lots of information out there about the menopause but hardly any if you have had a cancer diagnosis as well. Many people say to me they have no idea what their options are, who to ask for help, and that they feel really isolated in their experiences. I started this podcast because there was nothing out there when I was thrown into surgical menopause at the age of 39, which followed on from my cancer diagnosis aged 33.Through the episodes, I want to create more awareness, share information from our fabulous guest experts, doctors and other specialists in the cancer and menopause field. And of course, I will share stories from the people in our community.So that together we can work towards a better menopause experience. For all of us.More educated, better informed and less alone.Connect with Dani:Instagram @healthywholeme Facebook: @healthywholeme Website: menopauseandcancer.org Join Dani's private Facebook group: https://www.facebook.com/groups/menopauseandcancerchathubFor oodles of inspiration, healthy recipes, yoga classes and all round positivity go to her website: https://www.healthywholeme.com/Mentioned in this episode:Subscribe to the Menopause and Cancer YouTube Channel here: https://www.youtube.com/@MenopauseandCancer

Happy New Year 2024! To celebrate the new year, Spotify sent me a bunch of data points about 2023. I was particularly interested in one question: which conversation moved people the most? I already knew which episode people played the most. (That's episode 17 with Bernardo Kastrup.) But to listen is one thing. To share with friends and family is another. The most shared episode was my conversation with Helen Fisher, titled "A Cultural Biology of Sex, Love, and Monogamy". It was one of my favourite conversations, too. Fisher offered a sweeping take on romantic love, combining fascinating anthropology with practical tips about maintaining passion in relationships. She even convinced my parents to re-design their TV arrangement... Perhaps it deserves one more share. So here you go! ___ ORIGINAL SHOW NOTES Why do we love? And how much does our culture shape the way we do so? In this episode, Ilari talks with Helen Fisher about the powers that drive and shape our romantic relationships. Ilari and Professor Fisher discuss: Is romantic love a modern invention? Is monogamy a social invention?  Do men care more about sex? Do women care more about romance? Why agriculture, especially with the plough, caused havoc in romantic relationships. Why divorces might be on the decline. A science-based guide for maintaining romantic relations (based on couples who are still in love after 25 years) Why (certain) antidepressants can kill the sex drive and blunt romantic love (to read more, see the end of the notes) How common is polygamy or polyandry? Where in the world do we find most "free love"? Why did homosexuality evolve? Names mentioned Irenäus Eibl-Eibesfeldt (as recounted by Alison Gopnik in her The Gardener and the Carpenter) Bill Jankowiak Robert Sternberg (see episode 7) Anderson Thompson Bertrand Russell  Technical terms and ethnic groups mentioned Ventral tegmental area VTA Hypothalamus Dopamine, testosterone, oxytocin, vasopressin, serotonine Monogamy (serial or lifelong; social or biological) Polygamy (several wives) and polyandry (several husbands)  Tlingit (the polyandrous Inuit society with wealthy women) Oneida community (in New York State) Dig Deeper Antidepressants: To read more about the possible effects of SSRIs on sex drive and romantic love, see ⁠Tocco and Brumbaugh (2019)⁠. Below is a list of possible alternatives 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). Polyamory: In the episode, Professor Fisher suggests that many Amazonian tribes have informal polyandry, i.e. women have many partners, albeit only one formal husband. However, there are ⁠non-academic sources⁠ suggesting that formalised polyandry is common in the Zo'é community in Amazon. For some of these photos of Zo'é and other Amazonian tribes, many of whom exhibit remarkably liberal attitudes to sex, see the ⁠recent Amazonia exhibition⁠ in the London Science Museum.

The power of repetition is undeniable. A lie, repeated often enough, can become the accepted truth. This "illusion of truth effect" applies to all areas of life, including healthcare. In the case of medications like SSRIs and SNRIs, which are commonly prescribed for depression and anxiety, the illusion of truth can have serious consequences.  The illusion of truth can lead patients to underestimate risks. They may see these medications advertised as safe and effective, without fully understanding the potential downsides. This can lead them to blindly accept the doctor's recommendations without questioning or seeking further information. Don't let the illusion of truth cloud your judgment—ask questions. This is where informed consent becomes crucial.Can Antidepressants Induce Suicide, Violence & Bizarre Behavior?Note: This podcast episode is designed solely for informational and educational purposes, without endorsing or promoting any specific medical treatments. We strongly advise consulting with a qualified healthcare professional before making any medical decisions or taking any actions.*If you are in crisis or believe you have an emergency, please contact your doctor or dial 911. If you are contemplating suicide, call 1-800-273-TALK to speak with a trained and skilled counselor.RADICALLY GENUINE PODCASTDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / X (Twitter)Substack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically Genuine—-----------FREE DOWNLOAD! DISTRESS TOLERANCE SKILLS—----------ADDITIONAL RESOURCES2:30 - What Is Cognitive Ease and How It Blocks Your Critical Thinking - Learning Mind3:00 - Thinking, Fast and Slow: Daniel Kahneman3:30 - Science and Its Skeptics | The New Yorker7:30 - Newsom Admits to Cleaning Up SF For Major Summit, CA Reps Respond - California Family Council9:30 - How Fox News and CNN Have Changed in the Last Decade11:00 - Study shows that repeated statements are more often judged to be true, regardless of a person's age or prior knowledge | Vanderbilt University13:30 - How to survive the medical misinformation mess - Ioannidis - 2017 - European Journal of Clinical Investigation - Wiley Online Library26:30 - Role of antidepressants in the treatment of adults with anorexia nervosa - PMC35:00 - Vaccines for preventing influenza in healthy adults (Review) - Cochrane Review39:30 - Decline in Seasonal Influenza Vaccine Effectiveness With Vaccination Program Maturation: A Systematic Review and Meta-analysis48:00 - Just-world hypothesis - The Decision Lab

Join L. Joseph Parker, a research physician, as we explore the intricacies of depression treatment. We'll delve into the prevailing theories about serotonin, the delayed effects of SSRIs and SNRIs, and the emerging neuroplastic theory of depression. Discover how ketamine offers rapid relief and its potential synergy with traditional antidepressants. We'll also discuss the risks and benefits of these treatments and the importance of investing in further research to address this critical issue. L. Joseph Parker is a research physician. He discusses the KevinMD article, "Can ketamine and SSRIs offer a complete depression treatment?" Our presenting sponsor is Nuance, a Microsoft company. Together, Microsoft and Nuance are leveraging their rich digital technology and advanced AI capabilities to tackle some of health care's biggest challenges. AI-driven technology promises to revolutionize patient and provider experiences with clinical documentation that writes itself. The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled solution that automatically captures patient encounters securely and accurately at the point of care. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows. Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 85 percent of patients say their physician is more personable and conversational. Discover AI-powered clinical documentation that writes itself. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo. VISIT SPONSOR → https://nuance.com/daxinaction SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended GET CME FOR THIS EPISODE → https://earnc.me/a1978F Powered by CMEfy.

Dennis discusses MDMA therapy for PTSD with guest Emily, a pharmacist. They explore how MDMA is being researched as a treatment for combat-related PTSD, especially when conventional medications like SSRIs and SNRIs fall short. MDMA offers a unique approach by providing stimulating effects while fostering empathy and helping patients reprocess traumatic memories. Emily emphasizes the importance of integration in therapy. Clinical trials have shown promising results, with 67% of participants achieving remission from PTSD. The episode also touches on the challenges and progress in getting MDMA therapy approved and accessible to patients. Thank you to Delta Development Team for in part, sponsoring this podcast. deltadevteam.com For more content go to www.prolongedfieldcare.org Consider supporting us: patreon.com/ProlongedFieldCareCollective

Menopausal vasomotor symptoms occur in about 80% of women and have a significant impact on quality of life. Hormone replacement therapy works well; however, it is often underused. Join host, Geoff Wall, as he evaluates Fezolinetant, a new medication to treat 'hot flashes.' The GameChangerHRT is vastly underused in menopausal women. Gabapentin and SNRIs may help with some vasomotor symptoms. Fezolinetant is effective for hot flashes and seems to be well tolerated. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint Health ReferenceLederman S, Ottery FD, Cano A, et al. Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study. Lancet. 2023 Apr 1;401(10382):1091-1102. doi: 10.1016/S0140-6736(23)00085-5. Epub 2023 Mar 13. PMID: 36924778.https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00085-5/fulltext Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss the pros and cons of hormone replacement therapy in women with vasomotor symptoms.2. Discuss the role of fezolinetant for treatment of vasomotor symptoms.  0.05 CEU/0.5 HrUAN: 0107-0000-23-365-H01-PInitial release date: 11/27/2023Expiration date: 11/27/2024Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagramDownload the CEimpact App for Free Continuing Education + so much more!

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

A few weeks ago, MS3 Bilal Rana hosted an episode on Mood Disorders. This is a two-part follow-up to that episode, with a packed and powerful review of the pharmacology of mood disorders – what are the drugs we use to treat mood disorders, and how do they work? In part 1, we cover SSRIs, SNRIs, TCAs, atypical antidepressants, MAU inhibitors. Let's go!

Physician Assistant and prior C&P examiner Leah Bucholz discusses Erectile Dysfunction as it relates to PTSD in VA disability.Leah discusses the relationship between erectile dysfunction (ED) and mental health disorders like PTSD, depression, and anxiety in the context of VA disability. She explains that ED can be service-connected either directly (primary) or secondarily due to other service-connected disabilities, such as mental health disorders. Leah emphasizes the importance of supporting VA disability claims with peer-reviewed literature, citing several studies from the Journal of Sexual Medicine that establish a significant link between PTSD in veterans and sexual dysfunction. She also mentions that medications used for treating mental health disorders, such as SSRIs and SNRIs, can contribute to ED. While not an expert on VA disability ratings, Leah briefly touches on them, explaining that ED generally receives a special monthly compensation, and the rating can vary based on specific conditions like testicular atrophy or physical deformities.If you would like more information on our services including Independent Medical Opinion Letters often referred to as nexus letters and records review, please check us out here: https://www.prestigeveteranmctx.com/#veterans #va #medical

This episode is sponsored by Charm Economics.  In this podcast episode, Dr. Robert McCarron discusses the urgent need for improved mental health training for primary care physicians and specialists. As the founding director of the UC Davis Train New Trainers Primary Care Psychiatry Fellowship, Dr. McCarron aims to expand access to mental healthcare delivery, emphasizing the importance of addressing both physical and emotional pain in patients. The episode covers three key components of treatment: therapy, medication, and whole person care. Dr. McCarron advocates for empowering patients in decision-making and planting the seed for treatment, rather than pushing them into therapies they may not be ready for. He provides an overview of commonly used antidepressants like SSRIs and SNRIs and highlights the challenges of finding therapists due to the shortage of psychiatrists and insurance complexities.  His training program equips primary care providers with brief psychotherapy skills, such as cognitive behavioral therapy and motivational interviewing, to initiate treatment while patients wait for specialized care, ensuring better mental health support overall. Looking for something specific? Here you go! [00:05:00] Introduction to the Train New Trainers Primary Care Psychiatry Fellowship program. [00:06:00] The importance of training primary care providers in addressing mental health issues. [00:10:00] Approaching patients with stigma against mental illness and behavioral health conditions. [00:13:00] Integrative or whole person care as an essential component of treatment. [00:19:00] Overview of different antidepressant medications (SSRIs, SNRIs, Wellbutrin, Remeron). [00:22:00] Challenges in finding a therapist and the need for increased mental health resources in primary care. [00:23:00] Mini therapies and training primary care providers to address mental health. Bio/links! Dr. Robert McCarron, D.O., is a board-certified psychiatrist and internist, having completed a dual residency in internal medicine and psychiatry at Rush University. As the founding training director of the combined internal medicine/psychiatry residency program at the University of California, Davis School of Medicine, he received a prestigious 2.6 million dollar grant from the California Department of Mental Health. This grant aims to establish a comprehensive "Med Psych" curriculum that can be adopted by other primary care practitioner training programs, reflecting his dedication to enhancing mental health training in primary care. With a focus on unexplained physical complaints, depression, anxiety in primary care, and metabolic syndrome, Dr. McCarron has published extensively in these areas. He holds significant leadership roles, including the immediate past president of the Central California Psychiatric Society and the Association of Medicine and Psychiatry. Additionally, he serves as the Medicine/Psychiatry Section editor for Current Psychiatry and an Associate Editor for The Primary Care Companion to the Journal of Clinical Psychiatry. Dr. McCarron's contributions to various psychiatric associations and assemblies underscore his commitment to advancing general medical and psychiatric research, patient care, and medical education in California and beyond. Find Dr. McCarron on his LinkedIn.  Did ya know…  You can also be a guest on our show? Please email me at brad@physiciansguidetodoctoring.com to connect or visit www.physiciansguidetodoctoring.com to learn more about the show! Socials: @physiciansguidetodoctoring on FB  @physicianguidetodoctoring on YouTube @physiciansguide on Instagram and Twitter

Drs. Hope Rugo and Kristin Rojas discuss advances in the management of menopausal symptoms, fertility preservation, and bone health for women on endocrine therapy for breast cancer. TRANSCRIPT Dr. Hope Rugo: Hello. I'm Dr. Hope Rugo, your guest host of the ASCO Daily News Podcast today. I'm a professor of medicine and director of breast oncology and clinical trials education at the University of California San Francisco's Comprehensive Cancer Center. And I'm also an associate editor of the ASCO Educational Book.   In patients with hormone receptor positive breast cancer, the most common subset of the most common cancer in women worldwide, adjuvant endocrine therapy significantly reduces the risk of recurrence and death. However, prolonged estrogen suppression associated with the use of endocrine therapy can cause life-altering menopausal symptoms, bone loss, and fertility concerns. These issues impact the use of endocrine therapy and potentially breast cancer outcome.    Today, we'll be discussing mitigation strategies to manage the side effects of endocrine therapy, which we hope will improve our patient's quality of life and adherence to treatment with Dr. Kristin Rojas, who addressed these issues in a recently published article in the 2023 ASCO Educational Book. Dr. Rojas is an assistant professor of surgery and a breast surgical oncologist and gynecologic surgeon at the University of Miami Sylvester Comprehensive Cancer Center.    Our full disclosures are available in the transcript of this episode, and disclosures of all guests on the podcast can be found in our transcripts at asco.org/DNpod.    Dr. Rojas, thank you for being on the podcast today.   Dr. Kristin Rojas: Thanks, Dr. Rugo, thank you so much for having me. Thank you to ASCO as well. It's truly an honor to be here with you today.  Dr. Hope Rugo: Your excellent article provides an updated overview of the existing approaches and a little forward thinking for improving the quality of life of breast cancer patients who are receiving estrogen deprivation therapy, a really broad term we use for all the hormone therapy we use in ovarian function suppression in the treatment of breast cancer. And then you had a very nice session education session at the ASCO Annual Meeting discussing these issues. Can you briefly discuss the educational session, your speakers and topics, and then we'll get more into the details of this important topic?   Dr. Kristin Rojas: At our educational session at ASCO this year, I chaired the session and presented on managing the sexual side effects and menopausal symptoms of estrogen suppression. And I had two wonderful colleagues with me: Dr. Matteo Lambertini, who shared guidelines regarding bone-targeted agents and managing bone health during endocrine suppression. And then we also had Dr. Terri Woodard, who is a reproductive endocrinologist from MD Anderson, who spoke on managing fertility concerns, which is a very important topic right now.   Dr. Hope Rugo: Yeah, that's great. And it was such a fabulous session. Our listeners can view it online at asco.org if you missed this session. But let's talk a little bit about what was in your article and what was discussed. First, I think the physical and psychological effects of cancer care we know are critical components of survivorship care. Can you tell me a little bit more about that and how we need to understand that as oncologists?  Dr. Kristin Rojas: So, as you know, as treatment continues to improve, our cancer outcomes are improving and the population of survivors continues to grow. So, I think that for many breast cancer patients, or having the diagnosis of breast cancer, becomes more of a chronic illness and less a life-threatening issue for some. I think that the conversation is now changing from “Will you live?” to “How will you live?” And I was thrilled to see that other big organizations, along with ASCO, are prioritizing managing these important symptoms in survivorship. Because I think that, as most patients will be on some form of estrogen suppression, managing the toxicity of these therapies, as you pointed out, probably does influence treatment adherence, which directly translates to an oncologic improvement. So, it's not just managing these soft symptoms, it actually will have a direct influence on probably overall survival along with disease-free survival.  Dr. Hope Rugo: Yeah, I think that's incredibly important and it's not just about doing the exam and finding out symptoms that might signify recurrence, it's really trying to address the effects of the treatment patients have gotten of chemo and their ongoing treatment with endocrine therapy that's so incredibly important. And now, of course, in medical oncology, we're adding on more agents which add to symptoms. That'll be the topic of next year's ASCO educational session. What do you do with the CDK4/6 inhibitors and managing those. But in more than 80% of women who are on the antiestrogen or various, I'm going to call hormone therapies, for early-stage breast cancer, vasomotor symptoms are a big issue. They're typically more severe in younger patients because of course they have estrogen and we take it away. So, how do we mitigate this problem in patients that can result in poor sleep and impact many aspects of one's psychosocial status? And these issues, not sleeping, of course, you make everything worse.  Dr. Kristin Rojas: Yeah, that's a really important point. And you're right, this is a really common symptom experienced by the majority of patients on endocrine suppression. And not only those patients, but patients with triple negative disease who are put into menopause from chemotherapy, etc., along with women with cancer of other disease sites. And so, as the director of our program at the Sylvester Comprehensive Cancer Center, the program is called MUSIC, which stands for Menopause Urogenital Sexual Health and Intimacy Clinic.    This is a very common symptom that patients often report. And one of the important things about this that I've realized is that hot flashes or vasomotor symptoms can actually have a pretty varied presentation. So, it's not just intense sweating. Sometimes these patients can present with palpitations, panic attacks, and they don't even realize that they're hot flashes. This is an effect of estrogen suppression and it's a central mechanism. So, it's probably related to hypothalamic dysregulation regarding how our body senses temperature changes, but it results in widespread flushing and sweating and those other aspects I told you about.   So, we've known for a long time that there are some behavioral modifications that can help with vasomotor symptoms or hot flashes. But now, we actually do have some pretty effective pharmacologic therapies for these patients as well, for whom behavioral modifications aren't completely helping the issue. Or, as you said, when patients are being woken up all night long with these hot flashes, it totally disrupts how their day goes and disrupts coping with their disease and all the other aspects of their treatment.   So, there's some effective treatments that we have. One of those being cognitive behavioral therapy has been shown to be helpful. The data on acupuncture is mixed, but I'm hopeful about this. And then the pharmacologic therapies we have. Traditionally or historically, clonidine, which is an alpha agonist, has been used along with gabapentin. But I think when choosing a medication to prescribe to a patient for hot flashes, you have to take into account the side effect profile. Clonidine does have some issues with blood pressure rebound, and gabapentin is really only effective in large doses, which can be very sedating for patients.    In the MUSIC Sexual Health After Cancer program, we typically stick to low dose SSRIs or SNRIs. I usually go with venlafaxine at a really low dose of 37.5 milligrams, and I can titrate up. I have patients take it at night in case they feel a little foggy when they first start it. But more recently, we've started using oxybutynin, which is an anticholinergic medication originally FDA approved for overactive bladder. I use the XL formulation, or you can do 2.5 or 5 milligrams BID. And this, in a study a few years ago, was shown to significantly reduce hot flashes and improve quality of life in a placebo-controlled trial.   So, important aspects of side effects of these medications with SSRIs or SNRIs working in the MUSIC Sexual Health After Cancer Program, sexual health concerns are often an issue, so those drugs can be libido zappers sometimes. But, the biggest side effect I've come across with oxybutynin for patients is dry mouth, and usually that resolves after a little while. So, we've had a lot of success in managing patients' hot flashes with these medications.  Dr. Hope Rugo: That's great and incredibly helpful. And I will say that as we're talking about these issues on this podcast, this is really important for all of our staff and our clinics because most of us don't have a fabulous clinic like the one you've started. But we are managing this with our staff, our APPs, and other areas that our patients are seeing. If everybody has this education, it will really help in the management of symptoms. And I just want to point out that venlafaxine was the first drug to be studied in this area really successful, but that we can use a whole host of different antidepressants. If people have side effects from one another, one may work really well, and generally low doses work well. The oxybutynin was such a very cool study. I think that's a great additional option.    In addition to hot flashes, we also see genitourinary syndrome of menopause, and that's part of what you deal with every day in your clinic, GSM. And this can be not just vaginal dryness, which is bad enough, but also increased infections, painful sex, recurrent bladder infections and also reduced libido, which is a really big issue, we just don't talk about very much. What's the most effective and safe treatment for GSM? And we use a lot of low dose vaginal estrogen and a variety of delivery mechanisms. What are the risk and benefits when patients really need something more?   Dr. Kristin Rojas: GSM, or genitourinary syndrome of menopause, is this newer umbrella term for what we used to call vaginal atrophy. And you're right, it encompasses not only dryness, but all the other changes that can happen to the vulvovaginal mucosa along with anatomic changes to the pelvic floor. This is critically important, I think, that we address these issues or these potential side effects at the time of endocrine therapy prescription because what we have found in our program is that while hot flashes might get better, these symptoms do not get better. And left untreated, they get worse.   And one of the surprising findings that we have presented earlier at another conference this year was that almost half of our patients, when they had their pelvic exam in the program, were also found to have vaginal stenosis. So narrowing and shortening of the vagina, making penetrative sex actually impossible. So it's really not just dryness, but a host of these other symptoms that go along with that. I like to break this down in a really simple way because I know that a lot of providers may be intimidated when patients might bring this up. But I think about it this way. Number 1, eliminate irritants. Number 2, moisturize. Number 3, lubricate. And 4, address the pelvic floor.   Oftentimes when patients present in the MUSIC program, they've been putting a lot of over the counter topical therapies on the vulva and the vagina using intravaginal washes. One of the biggest offenders of some of these symptoms is artificial fragrance, which we can actually develop an allergic reaction to, which manifests as burning and stinging. So these patients may also report burning and stinging in addition to dryness. These offenders can be in all kinds of products. So not only feminine washes, which I don't recommend in our program, but things like bath bombs, bubble bath, toilet paper. And so we kind of go through an inventory of everything that's touching the delicate tissues of the vulva and the vagina and try to back off those products.   The second thing is moisturization. It's important to talk to patients about the difference between moisturization, which I say is for maintenance, and lubricants, which are for PRN use sexual activity. But I tell patients, "lubricants for love." That's how I differentiate the use of these two different types of products because they have different properties. Usually after eliminating irritants, our first step is to start with a non-hormonal moisturizer because there's some really good high-tech non-hormonal moisturizers out there, specifically those containing hyaluronic acid, which pulls moisture from the environment and holds it on the skin. And by using this first—this is my personal opinion—but I think by improving the mucosa a little bit and kind of improving the dryness, maybe even the elasticity a little bit, I think that when patients do have persistent symptoms after using regularly these non-hormonal moisturizers at least three times a week, that adding in a low dose vaginal hormone at that time, instead of putting it on completely atrophic mucosa, you're putting it on kind of like a pretreated mucosa, which I think might decrease systemic absorption.   I'm so glad you brought up vaginal estrogen. I could give an entire talk just on that, so I'd be happy to do that next year for ASCO if anybody wants. But it is very controversial. Historically, there have not been studies showing an increased risk of recurrence with the use of local estrogen therapy, so estrogen in the vulva and the vagina. However, there was a recent study that came out this year that was a large analysis of breast cancer patients receiving different types of hormone therapy. And in a subset analysis of the group who got local vaginal estrogen, just in those patients on aromatase inhibitors, there was a slightly, but statistically significant–according to their analysis–increase in the risk of recurrence. I think there's some issues with this analysis because it was a large study and there's a lot of recall bias and measuring this in patients is really challenging. But I think it's still important to mention because a lot of patients are going to read about those things, these types of studies.   The way I approach it is to start with the lowest dose and I start with infrequent dosing. If patients have persistent symptoms, I start them with once a week or twice a week, which is different from the original pharmacokinetic studies of higher dose estrogens, which showed a bump in their serum estradiol when they used it every night for two weeks. So I actually do the opposite and taper them up. I'll do once a week to twice a week. And usually, patient symptoms are resolved at that point.   But I do want to point out, that's a great option for patients on tamoxifen because mechanistically, as you know, it probably doesn't matter if they have a little bump in their serum estrogen. But for the patients on aromatase inhibitors, we actually have a new kid on the block, a vaginal androgen called prasterone or DHEA. I dose this in the same way, titrate it up. But this can be really helpful for patients on aromatase inhibitors because the ALLIANCE trial showed that for those patients on AIs that their systemic estrogen levels do not increase. And so that's kind of how I manage that discussion. I do think it takes some multidisciplinary collaboration, so I always involve my medical oncology colleagues on this.    Lastly, lubricants. So, everyone seems to be really into using water-based lubricants, but I try to tell patients, unless you're depending on condoms for STD or contraception protection, silicone-based lubricants that are like preservative-free and don't have a lot of those gimmicks or additives, are great—they stay slippery for longer—and there's some really great brands out there. And then for patients who still have persistent pain with sex, we address the pelvic floor, which is either through the use of dilators, referring them to pelvic floor physical therapy, or other sexual devices that we use in the MUSIC program.  Dr. Hope Rugo: This is really helpful, and I think that for many of us in practice, we really want to get the specifics of what you use. I think this prasterone, the idea of DHEA is really very interesting and something that personally I haven't used, but we did use in the distant past before there was an FDA-approved version.   So I guess I have several questions just to ask about the details. So one is, when you prescribe this, do you find it's generally covered by insurance? And when you say low dose, do you mean just try it once a week? And then do you use the estrogen tablets, the brand names are often Yuvafem or Vagifem, we often use those twice a week. How often do you use them and do you use the estrogen ring also? What are the absolute specifics of what you're recommending to these women? And do you feel like sometimes in patients who are developing these symptoms that early use can help avoid the more severe symptoms and therefore reduce the exposure?   And lastly, just to say, that paper which was so interesting about the slightly increased risk of recurrence, I felt was so flawed in terms of what people were using and if they were taking their hormone therapy and risk of recurrence, the risk of the cancer itself, that I really felt like I couldn't make anything out of it in terms of the risk to patients. But I'm really interested in your specific recommendations.  Dr. Kristin Rojas: Thanks for asking about specifics. And I'm happy to give our treatment algorithms here, which we also discussed in our session and we listed in our EdBook manuscript. We do pelvic exams in the MUSIC program and I often find that there's very specific points in the vestibule or the opening of the vagina that are tender and have pain, specifically, what's known as the posterior fourchette, which is the kind of connection between the right and the left side towards the posterior aspect. So, I usually start with a 1% estradiol cream and have patients tap it to the outside and then bring in a dilator and have patients use not only a silicone lubricant, but put some of the estradiol cream on the dilator. And so that brings the product up to the top of the vagina for patients that have some of those anatomic changes that I discussed.   So this is 1 option, and we really don't have a lot of issues with insurance authorization for the cream, just every once in a while. We can also use a 4 microgram or a 10 microgram dose of estradiol, which is a tablet, which are newer options. This is in contrast to the old pharmacokinetic studies that use 25 micrograms. So this is much, much lower. I do run into some prior authorization issues with those because there tend to be newer versions of this. But as you mentioned, the estradiol ring, which I do think is a great option and when you calculate it out, releases a very low dose of estradiol every day. And it's good for patients who want a more low maintenance regimen. The only challenge I've had with that is it's a large rigid ring. And for patients who already have those anatomic changes, it can be really hard to place that in the vagina.   And so, just like you said, early prevention and treatment of these issues can prevent not only anatomic changes, but even potentially the need for exposure for larger doses of hormones. For all of those options, I tend to do it once or twice a week and then can move up. But we sometimes get kind of creative in how we use these options in terms of placing them on the dilator, placing them externally. For patients that have recurrent urinary tract infections, I also have them kind of tap some of the estradiol cream around the urethra as well to improve the urethral and potentially bladder microbiome and decrease risk of recurrent UTIs.  Dr. Hope Rugo: That's really interesting, and I think those specifics are incredibly helpful. We also will check, although I have to say there's no data to support it, the serum estradiol levels in patients who are using more than our minimal amount. We have plenty of studies that have shown that there really isn't systemic estrogen if people are using very low doses. But we will check sometimes, just sometimes people use these topical creams where they get premenopausal levels of estrogen, which of course we don't want. So, this is an incredibly helpful and useful discussion.    One of the other things that happens for these patients and our younger patients, which breast cancer is still increasing in small numbers in younger patients every year, and many of these patients have hormone receptor positive disease. And it just breaks your heart to see a 38-year-old who is planning to get pregnant next month with their new partner who develops a hormone receptor positive breast cancer. and we want to give people all the options they possibly can. We are strong proponents for harvesting eggs and either freezing eggs or embryos before you start treatment. And we figure we always have 2 weeks for breast cancer. We also use ovarian function suppression during chemo just for whatever help it might have.   But then after patients have finished their treatment and they're on hormone therapy, it's a really big issue for women about when they can have a child because we don't want to wait until they're 45. So, you had noted in your article that some women could take a break from endocrine therapy after 18 to 24 months to try and conceive. Can you tell me a little more about that?  Dr. Kristin Rojas: Sure. Well, this aspect of our discussion was very well presented by my colleague, Dr. Terri Woodard from MD Anderson, a reproductive endocrinologist, and she also put together the aspect of this for our manuscript. She talks about how fertility counseling and referral is probably underutilized, but definitely indicated for most of these patients who are of pregnancy age or premenopausal status. And observational data for a long time didn't show that pregnancy after treatment worsened oncologic outcomes. However, patients as well as many providers had reservations.   So, it's been very helpful that we now have a prospective, large, international trial known as the POSITIVE trial, the early results of which came out earlier this year, which showed that women, after 18 to 24 months, could interrupt endocrine therapy and did not have a worsened short-term oncologic outcome. And those are women with early-stage breast cancer. However, there is a concern that many patients do take longer to get pregnant in that age group or after treatment, potentially if they've received chemo. There is a concern about the duration of time that they're not on endocrine therapy afterwards, which might be further clarified in later analyses. So that's my takeaway from that study, which did show us that very helpful, reassuring information. But I think we're still waiting for the long-term data and it's definitely still a very important patient-centered discussion.   Dr. Hope Rugo: This is a really excellent point, and I think that one of the things of a trial like this, which is sort of a registry study, is that we're always going to speak with our feet to some degree. So, if patients have very, very high risk of recurrence and highly proliferative disease, we might not want them to stop at 18 months because their risks are so high early. So, it has to be a risk versus benefit discussion for individual patients, of course. But I think this data was incredibly reassuring.   It was interesting there were some patients who hadn't restarted their endocrine therapy. In the paper in the New England Journal, it told us that some of those patients were still trying to conceive. But one of the things that's going to be really important for these patients is to really make a big effort on the part of our clinical practices to get patients to restart their hormone therapy. It's very hard to do that, as you can imagine, in that setting.    Another area here is monitoring bone health. And I know that's not part of the MUSIC clinic per se because you're really focusing on GSM and other areas that we've just discussed, which are so incredibly important. And it's funny, bone health is silent, right? So, although some patients don't want to take aromatase inhibitors because they're worried about losing further bone density, they don't feel it. So that's, of course, a different kind of a toxicity. But we know that by suppressing ovarian function in young women, we cause a lot of bone loss, and in older women, already in menopause, that this continuous loss of bone increases the risk of fractures, which can be a huge impact on quality of life and even survival in some cases. So, we're really interested in trying to prevent bone demineralization and reducing the risk of fractures. I believe that Matteo Lambertini from Italy discussed this in your paper and that there's a lot of discussion about use of denosumab and zoledronate. I wonder if you could just comment a little bit on that in our last couple of minutes.  Dr. Kristin Rojas: Well, as you said, my colleague Dr. Lambertini put this aspect of our paper together, but he did put together a very nice summary of bisphosphonates and denosumab and separated their use by premenopausal and postmenopausal patients because the data surrounding those patient populations is slightly different or nuanced. But as you mentioned, it is important to monitor these patients' bone density. We have our standard recommendations such as a calcium-enriched diet, resistance and weight-bearing exercise, and vitamin D for patients, for those patients with a vitamin D deficiency or at risk of bone density loss. And so these pharmacologic agents can also help decrease bone mineral density loss and potentially decrease or likely decrease bone recurrences, which, as we know, influences survival. I think he provides a very nice summary of that, as you mentioned.  Dr. Hope Rugo: I think that's so incredibly important. And thank you for really emphasizing the weight-bearing exercise and checking vitamin D and making sure patients are taking vitamin D and at least some calcium. And then, of course, our institution, we work closely with our endocrinologists specializing in bone as well, when issues come up about risk of osteonecrosis of the jaw, and we require dental clearance for everybody starting medication just to make sure that we've reduced risk to the patient. And then when we're trying to think about stopping denosumab and should we bridge with zoledronate to reduce the risk of fracture, we also talk to our bone doc. So it's really important.   And in our last just 1 minute, I know you were thinking of saying something about measuring estrogen in the blood in patients who are using vaginal estrogens. Do you do that?   Dr. Kristin Rojas: Yeah, great question. I'm glad you brought that up. We actually don't routinely do this in the MUSIC program, but it is an important aspect to think about today, because I don't know about where you are, but here in South Florida we have a lot of patients who are receiving therapies outside of the FDA-approved space and these are typically marketed as bioidentical hormones, which is a marketing term. Oftentimes, they'll get either transdermal formulations or pelleted hormone therapy that can result in really high superphysiologic testosterone or estrogen levels. And so we typically, for those patients, do try to get them off those non FDA-approved therapies because the safety of those is unknown.   Dr. Hope Rugo: That's really interesting and so helpful. Yes, I know this whole idea of bioidentical hormones drives me crazy, but I think that's great that you brought that up, actually. We do measure it. Who knows? I think if you're really worried, measuring “Yeah, everybody's hot flashes went away,” it's probably worthwhile checking.   This was such a fabulous conversation. I learned so much. We really appreciate your contribution to the educational manuscript, to the educational program, and your fabulous insights with us today. Thank you so much for participating on the ASCO Daily News Podcast. I think everyone will find this very helpful.   Dr. Kristin Rojas: Thank you so much for having me.   Dr. Hope Rugo: And thank you to you, our listeners, for joining us today. You'll find a link to Dr. Rojas and her colleagues' article in the transcript of this episode and in the 2023 ASCO Educational Book, which features practice-changing oncology research and a wide range of compelling studies on quality and equitable cancer care.    Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Thanks again.    Disclaimer:   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    Follow today's speakers:   Dr. Hope Rugo  @hoperugo  Dr. Kristin Rojas  @kristinrojasmd    Follow ASCO on social media:    @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:   Dr. Hope Rugo:  Honoraria: Puma Biotechnology, Mylan, Samsung Bioepis, Chugai Pharma, Blueprint MedicinesConsulting or Advisory Role: Napo PharmaceuticalsResearch Funding (Inst.): OBI Pharma, Pfizer, Novartis, Lilly, Genentech, Merck, Odonate Therapeutics, Daiichi Sankyo, Sermonix Pharmaceuticals, AstraZeneca, Gilead Sciences, Ayala Pharmaceuticals, Astellas Pharma, Seattle Genetics, Macrogenics, Boehringer Ingelheim, Polyphor  Dr. Kristin Rojas:   Honoraria: Pacira Pharmaceuticals  Consulting or Advisory Role: Roche Diagnostics, Merck  Research Funding (Inst): Bristol Myers Squibb Foundation       

Hi! I've been in the hospital with pneumonia! But enjoy this banger of an encore about: Serotonin! Dopamine! Norepinephrine! Neurotransmitters: what's their deal? Dr. Crystal Dilworth, aka Dr. Brain, stops by to have a spirited discussion about how chemical messengers change our moods and behaviors. We chat about depression, anxiety, what chemicals drive us to get off the couch, how antidepressants work, ADHD, addiction, the microbiome, new habits, quitting smoking, starting meditation, Oreos vs. cocaine, SSRIs vs. SNRIs, what it's like to hold a human brain in your hands and if she would donate hers to science. Also: what's up with "lizard brains?"Visit Dr. Dilworth's websiteFollow Dr. Dilworth on Instagram & TwitterA donation went to The Geena Davis Institute: seejane.orgMore episode sources and linksSmologies (short, classroom-safe) episodesOther episodes you may enjoy: Attention-Deficit Neuropsychology (ADHD) Part 1 with Dr. Russell Barkley, Attention-Deficit Neuropsychology (ADHD) Part 2, LIFE ADVICE: For anyone who needs some hacks, Dolorology (PAIN), Eudemonology (HAPPINESS), Chronobiology (CIRCADIAN RHYTHMS) Encore + 2023 Updates, FIELD TRIP: An Airport Full of Neuroscientists, Oneirology (DREAMS), Thanatology - NEW Interview (DEATH, GRIEF & MOURNING), Neuropathology (CONCUSSIONS), Molecular Biology (PROTEINS + SCIENCE COMMUNICATION), Awesomeology (GRATITUDE FOR LITTLE THINGS), Oikology (DECLUTTERING), Philematology (KISSING), Traumatology (PTSD), Victimology (CRIME VICTIMS), Personality Psychology (PERSONALITIES), Somnology (SLEEP),  Fearology (FEAR) Pt. 1, Fearology (FEAR) Pt. 2, Sports & Performance Psychology (ANXIETY & CONFIDENCE)Sponsors of OlogiesTranscripts and bleeped episodesBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, masks, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramEditing by Mercedes Maitland of Maitland Audio Productions, Jarrett Sleeper of MindJam Media, and Steven Ray Morris Transcripts by Emily White of The WordaryWebsite by Kelly R. DwyerTheme song by Nick Thorburn

Dr. Carrie Jones rejoins the Evolution of Medicine podcast to discuss the functional medicine approach to depression, anxiety and attention issues. She is an avid educator who specializes in stress and endocrine health. A recent systematic review found that the serotonin theory of depression is scientifically unsupported,  which raises the question: What does this mean for patients who use either SSRIs or SNRIs? Dr. Jones explains how she answers this for concerned patients and discusses her approach to resolving mood issues by looking for root causes. Other topics discussed in this conversation include rising mental health issues amongst teenagers in particular, group care, and mental health lifestyle factors, such as balancing neurotransmitters, stress management, social connection, nutrition, gut health and physical activity. Tune in and listen to the whole conversation to learn about the following from Dr. Jones: Examples of how blood sugar dysregulation can harm sleep quality and mental health Problems that can arise when supporting only one neurotransmitter Specific nutrients she uses for patients with mood dysregulation The potential for technology, especially continuous glucose monitors, to empower patients in their health journeys And much, much more!  

Physician Assistant and prior C&P examiner Leah Bucholz discusses Erectile Dysfunction as it relates to PTSD in VA disability.Leah discusses the relationship between erectile dysfunction (ED) and mental health disorders like PTSD, depression, and anxiety in the context of VA disability. She explains that ED can be service-connected either directly (primary) or secondarily due to other service-connected disabilities, such as mental health disorders. Leah emphasizes the importance of supporting VA disability claims with peer-reviewed literature, citing several studies from the Journal of Sexual Medicine that establish a significant link between PTSD in veterans and sexual dysfunction. She also mentions that medications used for treating mental health disorders, such as SSRIs and SNRIs, can contribute to ED. While not an expert on VA disability ratings, Leah briefly touches on them, explaining that ED generally receives a special monthly compensation, and the rating can vary based on specific conditions like testicular atrophy or physical deformities.If you would like more information on our services including Independent Medical Opinion Letters often referred to as nexus letters and records review, please check us out here: https://www.prestigeveteranmctx.com/#veterans #va #medical

This is another Ask Me Anything episode where I answer questions from you - my amazing community! This week's episode was inspired by this question: “ I've been struggling for a while. Tried antidepressants which seem to make me feel worse. Why? I'm not sure what to do anymore and would love to hear your thoughts.” I get so many questions like this so today we are going to deep dive into the world of SSRIs, SNRIs and benzos. This episode explores the most common side effects, the reasons why these medications may make some people feel worse, and the secret to successfully breaking up with your meds with minimal (or no) withdrawal symptoms when, and if, you decide it's time. Here's just a sneak peak of some of the topics we cover: What your doctor isn't telling you about the medication you're taking Steps for a smoother transition off SSRIs and SNRIs The connection between medication, gut health, and nutrient absorption Can you really tackle anxiety and panic without medication? My top natural and holistic solutions for targeting anxiety's root causes Please note it's important to always consult with your prescribing healthcare provider regarding any decisions or changes to your medication use. Resources & Products mentioned in this episode: Ep. 11 - The Real Root Causes of Anxiety [Pt.1] Ep. 15 - The Real Root Causes of Anxiety [Pt. 2] Melissa's Blood Test Discovery & Repair Kit Melissa's Instagram FREE Masterclass for those who struggle with autoimmune or autoimmune related conditions like PCOS or endometriosis Ep. 13 - Anxiety, Seasonal Allergies, Immune System Health & Covid The Breaking Up With Anxiety Group Coaching Program The ByeBye Anxiety Bundle The “How to Reprogram Your Gut” Workshop Vellum Health (code TAY10 for 10% off) If for some reason (because technology is not always our friend) the links in the show notes aren't working send me a DM on Instagram or send me an email hello@taygendron.com and I will get that link to you! For more information about all the Breaking Up With Anxiety offerings or to find most links, please check out: My Website: www.taygendron.com My Instagram: @tay.gendron Here are two free resources to get you started on your journey to anxiety freedom: “CALM” - Free 5 Day Mini Workshop to Soothe an Anxious Mind https://courses.taygendron.com/calm “The Three Secrets to Natural Anxiety Banishment” - free webinar training on why medication, therapy and meditation haven't been enough to banish anxiety from your life and what I recommend doing instead https://courses.taygendron.com/3secrets If you'd like to submit a question for future episodes, fill out this form https://bit.ly/ask-tay-anything in as much detail as possible. All questions will remain anonymous and you will be notified via email when your question is answered! Looking for a transcript for this episode? CLICK HERE! I hope you enjoyed this episode and I will see you in the next one!

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).

In this episode, we will discuss the most important updates from the American Diabetes Association's 2023 Standards of Care in Diabetes. Key Concepts The first-line therapy for type II diabetes is based on whether the primary goal of therapy is cardiorenal benefit (reduced risk of ASCVD, heart failure, or CKD) or glycemic and weight goals. For cardiorenal benefit, GLP1 receptor agonists and SGLT2 inhibitors are heavily emphasized. For glycemic control and weight gain, GLP1 receptor agonists (or GLP1/GIP in the case of tirzepatide) have a very favorable effect on weight loss and glycemic control. While metformin is still mentioned, it is no longer the sole, first-line therapy for type II diabetes. For patients with diabetes and a high risk of ASCVD (20% or higher), high-intensity statins, ezetimibe, and/or PCSK9 inhibitors are recommended to achieve an LDL less than 70 mg/dL. In patients with a history of ASCVD events, these same therapies are used to achieve a recommended LDL goal of less than 55 mg/dL. Among selected patients with diabetes and CKD with albuminuria, finerenone (a new mineralocorticoid receptor antagonist) is recommended to improve renal and cardiovascular outcomes. A variety of different therapies are now recommended for neuropathic pain, including gabapentinoids, SNRIs, TCAs, and several antiseizure medications (lamotrigine, lacosamide, oxcarbazepine, and valproic acid). A wide variety of other new recommendations are discussed in the episode, including NASH/NAFLD, obesity and weight management, special populations, diabetes technology, and health behavior changes. References American Diabetes Association. Standards of Care in Diabetes-2023. Diabetes Care. 2023; 46(1): S1-S292. https://diabetesjournals.org/care/issue/46/Supplement_1

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

The following question refers to Section 4.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by medicine resident Dr. Ahmed Ghoneem, and then by expert faculty Dr. Noreen Nazir. Dr. Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #21 Ms. J is a 57-year-old woman with a past medical history of myocardial infarction resulting in ischemic cardiomyopathy, heart failure with reduced ejection fraction, and major depressive disorder who presents today for follow-up. She reports feeling extremely overwhelmed lately due to multiple life stressors. She is on appropriate cardiovascular GDMT agents and is not prescribed any medications for her mood disorder. True or false: in addition to psychotherapy for stress management, it is appropriate to consider Ms. J for anti-depressant SSRI pharmacotherapy at this time to improve cardiovascular outcomes. A True B False Answer #21 Explanation The correct answer is FALSE. An ESC class 3 recommendation states that SSRIs, SNRIs, and tricyclic antidepressants are not recommended in patients with heart failure and major depression; this is based on data suggesting potential lack of SSRI efficacy for reducing depression or cardiovascular events, as well as safety data indicating an association between SSRI use and increased risk of CV events and all-cause as well as cardiovascular mortality among HF patients. Mental health disorders are associated with worse outcomes in patients with ASCVD and appropriate treatment effectively reduces stress symptoms and improves quality of life. Nonpharmacologic modalities of treatment (exercise therapy, psychotherapy, collaborative care) should be considered before pharmacotherapy to improve cardiovascular outcomes in patients with heart failure. Of note, the ESC suggests SSRI treatment be considered for patients with coronary heart disease (without HF) and moderate-to-severe major depression based on data that SSRI treatment is associated with lower rates of CHD readmission (RR 0.63), all-cause mortality (RR 0.56), and the composite endpoint of all-cause mortality/MI/PCI (HR 0.69) vs. no treatment. This is a class 2a recommendation. ESC also gives a class 2a recommendation to consider referral to psychotherapeutic stress management for individuals with stress and ASCVD to improve CV outcomes and reduce stress symptoms. The ACC/AHA guidelines do not provide focused recommendations regarding mental health considerations in patients with elevated cardiovascular risk. Main Takeaway It is important to consider mental health treatment in patients with ASCVD as mental disorders are associated with increased CVD risk and poor patient prognosis, and data support that mental health interventions can improve overall and CVD outcomes, as well as improve quality of life. Guideline Loc. Section 4.4 CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

Drs Madhukar Trivedi and Anita Clayton discuss how to approach patients with sexual dysfunction who are being treated for major depressive disorder. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984459). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Depression https://emedicine.medscape.com/article/286759-overview Treatment-Emergent Sexual Dysfunction Related to Antidepressants: A Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/19440080/ Citizen Petition: Sexual Side Effects of SSRIs and SNRIs https://pubmed.ncbi.nlm.nih.gov/29733031/ Association of Major Depression With Sexual Dysfunction in Men https://pubmed.ncbi.nlm.nih.gov/23645187/ The Changes in Sexual Functioning Questionnaire (CSFQ): Development, Reliability, and Validity https://pubmed.ncbi.nlm.nih.gov/9493486/ Structured Review of the Use of the Arizona Sexual Experiences Scale in Clinical Settings https://pubmed.ncbi.nlm.nih.gov/32236977/ Hypoactive Sexual Desire Disorder: A Review of Epidemiology, Biopsychology, Diagnosis, and Treatment https://pubmed.ncbi.nlm.nih.gov/27872021/ Erectile Dysfunction https://pubmed.ncbi.nlm.nih.gov/31030826/ Sexual Dysfunction With Major Depressive Disorder and Antidepressant Treatments: Impact, Assessment, and Management https://pubmed.ncbi.nlm.nih.gov/35255754/ Overview of the Rapid Antidepressant Effects Observed in the Zuranolone Clinical Development Program https://journals.lww.com/greenjournal/Abstract/2022/05001/Overview_of_the_Rapid_Antidepressant_Effects.161.aspx Flibanserin prescribing information https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022526lbl.pdf

This episode discusses some strategies for starting antidepressants in the elderly, the important role of titrating doses, the efficacy of SSRIs, the side effects and drug–drug interactions of different medications, and clinical tips for using SSRIs and SNRIs in this population. Faculty: Lauren Gerlach, D.O. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Updates on Geriatric Psychopharmacology Using SSRIs and SNRIs in the Geriatric Population

In this episode, we review the high-yield topic of Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) from the Psychiatry section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

There are very few people in the world who are truly altruistic, and even fewer brands. But one fragrance company is creating breakthroughs in depression research and pioneering new treatments to end the suffering of millions. We talk to Audrey Gruss, founder of Hope Fragrances and Hope for Depression Research, about:Her inspiring career path to Director of Advertising and Creative Services Worldwide for Elizabeth Arden, in a time when men ruled the industry.Shocking facts about depression: Over 20 million adults have depression in the U.S. each year and over 350 million globally. And according to Audrey, “50% of the people who need antidepressants, who take this type of antidepressant [SSRIs like Prozac and Lexapro, and SNRIs ] do not respond to them."Hope for Depression Research: A foundation that Audrey founded in 2006 in memory of her late mother, Hope, who suffered from clinical depression. While researching her mother's illness, she discovered that the funding towards depression research was limited and so she decided to assemble a task force of the top leading neuroscientists in the world. By allowing them to share information in real-time, HDRF has made incredible discoveries into the origins, diagnosis, treatment and prevention of depression and its related mood and other emotional disorders, with the ultimate goal of finding a cureThe Hope Fragrance Collection: In 2017, Audrey created a line of luxury perfumes, body care and candles, that donates 100% of its profits to Hope for Depression Research.The future of depression research and treatment.

This episode is for the inner neurology nerd in us all. Wondermed Lead Clinician Lauren Swanson answers the one question host April Pride gets most often about psychedelics: “Can I take my SSRIs?” While Field Trip Health's Seattle ketamine clinic director Dr. Bridget Carnahan answers, “How does ketamine affect the brain?”After listening to this episode, you will have a better understanding of: - How ketamine-facilitated neuroplasticity heals the effect of stress on our brain- Ketamine use with SSRIs, SNRIs, stimulants, benzos - Why ketamine is right for some & not for others-The potential use of ketamine for ADHD treatment Resources:Definition ‘neuroplasticity' [LINK]Rewire Your Brain: The Role of Neuroplasticity in Anxiety & Depression [LINK]The Guides I ReferencedReduced Glutamate in the Medial Prefrontal Cortex Is Associated With Emotional and Cognitive Dysregulation in People With Chronic Pain [LINK]The Body Keeps the Score Bessel van der Kolk Hosted on Acast. See acast.com/privacy for more information.

Episode 125: Non-opioid Chronic Pain Management Dr. Axelsson and Jesse explain how to treat chronic pain without opioids. Written by Anika Soleyn, MS4, Ross University School of Medicine. Edited by Jesse Lamb, MS3, American University of the Caribbean; Hector Arreaza, MD; and Fiona Axelsson, MD.This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, 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.Axelsson:Welcome to the first episode of 2023, Happy new year! Today is January 10, 2023.What is chronic pain?According to the International Association for the Study of Pain, chronic pain is nonstop or reoccurring pain that lasts more than 3 months or beyond the expected clinical course of illness. Chronic pain can adversely affect well-being and quality of life. We used to think of pain as a response to tissue damage, and as the tissue heals, the pain dissipates, but chronic pain is much more complex than that because there may be no evidence of tissue damage, yet the nociceptors keep sending signals to the brain that there is damage.There are 3 options for the management of chronic pain: non-pharmacologic, nonopioid pharmacological and opioid management. CDC recommends a combination of nonpharmacological and non-opioid management for chronic pain. The 7 most common chronic pain conditions are neuropathic pain, fibromyalgia or chronic pain syndrome, osteoarthritis, inflammatory arthritis, low back pain, chronic headache, and sickle cell anemia.Opioids in long-term care facilities.The use of opioids for the treatment of pain is common in the post-acute and long-term care setting. From the AFP Journal, the Choosing Wisely Recommendation states: “Don't provide long-term opioid therapy for chronic non-cancer pain in the absence of clear and documented benefits to functional status and quality of life.” The Society for Post-Acute and Long-Term Care Medicine published a statement in 2018 about the use of opioids. It states that the prescription of opioids should be based on an interprofessional assessment specifying why opioids are needed. When long-term opioids are not being used for cancer, palliative care, or end-of-life care in a long-term facility, a tapering plan must be “individualized and should minimize symptoms of opioid withdrawal while maximizing pain treatment with non-pharmacologic therapies and non-opioid medications”. Long-term opioid prescriptions should be reviewed regularly and take into consideration the potential harms of opioids. Clinicians are encouraged to offer alternatives such as behavioral therapy, non-opioid analgesics, and other non-pharmacologic treatments whenever available and appropriate.Initial assessment: Identify biopsychosocial factors and identify if the source is neuropathic, nociceptive, or central sensitization. This can be a challenging process and it may require several visits to determine the origin of pain. Neuropathic pain is due to nerve damage or irritation while nociceptive pain is due to tissue damage. Central sensitization is an abnormal response of the nociceptive system. There are changes in the nervous system that alter how it responds to sensory input that causes widespread pain with no apparent cause or in response to mild sensory input. Some examples include fibromyalgia, migraines in response to brushing hair, surgical scar pain, etc.Set goals and expectations: It is crucial to set up patient expectations if they have chronic pain. They should understand that pain can be improved to a manageable level but not always eliminated. Patients should have routine follow-up visits with education, and reassurance since they are shown to improve outcomes of pain management. Specific goals such as improved mobility and ability to do certain enjoyable tasks are more reasonable and specific goals than a goal of pain elimination. A good physician-patient relationship and clear communication are essential here. Patients could obviously become deeply upset at the prospect of pain that can't be eliminated, and those who have received opioids for their pain in the past could be even more distraught at the thought of not getting them now or needing to reduce their dose. The physician should be ready to have this discussion with their patients that have chronic pain and be ready to address their concerns appropriately. Reduce catastrophic thinking: Pain is an alarm system letting someone know there is some sort of damage. Because of this, it makes sense that a patient would respond to pain with anxious and catastrophic thinking. Patients who understand their own chronic diseases are more likely to be actively involved in their treatment, so understanding is crucial in the management of pain. Reducing fearful thoughts such as "there must be something wrong," and "hurt means harm'” is an important first step toward pain self-management and making sure the strategies attempted are effective.Rehabilitation: Focused pain clinics often include educational group classes for patients in distress. The programs include explanations for why pain might be present with no pathological factors. It also includes relaxation and mindfulness that help patients soothe themselves during attacks. The brain plays a big role in the experience of pain. Changing how your brain relates physical pain to stress and reducing those psychosocial barriers through self-care helps with pain management. Finding things that make you physically stronger like physical therapy or occupational therapy help, but also increasing mental strength by doing things that make you happy and having a quality social life is a strong determinant of how the brain perceives physical pain. Consistency is key in pain management even after the patient begins to feel better.Non-pharmacologic therapy – Most of what we will talk about today is non-pharmacological treatment. We will discuss the options and goals of different treatments. Chronic pain treatment should start with non-pharmacological approaches and then you can add medications if necessary. Again, these approaches aim to increase functionand reduce progression despite chronic pain. There should be a consistent non-pharmacological regimen, even if medications are added later. The three main approaches will be physical therapy, psychological therapy, and some integrative medicine methods.Physical therapy. The objective of physical therapy is to improve physical function. You should recommend programs that are specific for patients' limitations and the physical therapist should have trained specifically in chronic pain treatment. This ensures they do a proper initial evaluation and select appropriate therapeutic methods such as Therapeutic exercise: Sometimes patients can become so fearful of painful movement that they have deconditioned muscles. In the geriatric population, some patients are so afraid of falling, that they avoid any form of movement whatsoever, therefore almost certainly leading to falls due to deconditioning of those muscles. Adding small amounts of exercise as tolerated can begin to recondition patients and help them build strength. Patients with severe osteoarthritis are more likely to tolerate aquatic exercises. Therapeutic exercise programs may be available at the physical therapy facility or community centers. Patients can even find videos on the internet of tai chi, yoga classes, Pilates, and low-impact fitness programs. Exercise can certainly reduce pain and improve function, with few adverse effects but make sure patients tolerate the exercises and are not pushed beyond their limits. Stretching can also improve range of motion and strength, especially in chronic lower back pain patients. Psychological therapy:Cognitive-behavioral therapy. It is the most researched and recommended psychological treatment for chronic pain. It's normally recommended in conjunction with patient education, physical therapy, and exercise. CBT can be used after introducing meds and/or after surgery. There are 2 components to cognitive behavioral therapy: cognitions and behaviors. CBT addresses the way that patients' thoughts (cognitions) affect their actions and vice versa. This begins with helping patients identify situations and environments that trigger their pain and what they actually experience emotionally, behaviorally, and physically when they have pain.CBT addresses mental responses that may worsen pain, so patients learn to think about how they view their pain. To do this, they use a range of specific behavioral strategies such as relaxation and controlled-breathing exercises, activity pacing, pleasurable activities, improving their sleep, and cognitive reappraisal strategies, such as reframing negative situations to positive or practicing gratefulness.Complementary and integrative health therapies.-Mindfulness-based stress reduction. Mindfulness is the ability to be fully present where we are and what we're doing, and not be overly reactive or overwhelmed by what's going on around us.-Progressive muscle relaxation. For instance, tensing/relaxing muscles throughout the body along with positive imagery and meditation.-Biofeedback. During biofeedback, you're looking at biological signs, and feedback that is being correlated to physical sensations in your body to recognize the correlation between physical signs and symptoms of chronic pain. You're connected to monitors, such as electromyograms or electroencephalograms, to quantify muscle tension, brain waves, heart rate, and blood pressure to see how fluctuations and abnormal numbers physically feel in the body.-Massage therapy. It can relax painful muscles, tendons, and joints and relieve stress. The effect of pressure in certain areas that are tender causes relaxation and secretion of endorphins that can calm pains. That's why massage therapy can actually be addictive for some people, because of the endorphins. Another benefit of massage therapy is that it can help with improved absorption of medications due to improved circulation.There are many other integrative health therapies including Reiki, hypnosis, therapeutic touch, healing touch, and homeopathy. However, these are not well-researched and can't really be endorsed by evidence-based medicine.If patients are interested in trying complementary, integrative health therapy, you can guide them to practices that are at least safe. Some therapies can end up being harmful, such as herbal remedies or supplements with potential toxicities or known interactions with medications, so those should be taken cautiously. Make sure your med list while taking your history includes supplements and herbs patients might be trying. Shirodhara is an Ayurvedic approach to stress relief that involves having someone pour liquid — usually oil, milk, buttermilk, or water — onto your forehead.Herbal or plant-based treatments have also shown some efficacy in published studies. Ginger, turmeric, St John's Wort, and a handful of others seem like they could have some beneficial effects either on their own merit or as an adjunctive with other non-opioid therapies. Caution should be taken, though, as some of them, particularly St John's Wort, have been shown to have negative impacts on serum levels of opioids when used in combination with them due to their effects on the liver cytochrome system. Data is also rather mixed, with some studies showing reasonable efficacy and others showing almost none. If your patients want to take herbal supplements, it is essential to be diligent about checking their efficacy and interactions with other therapies to ensure safety. The physician should also be clear when discussing current medications to ask specifically if they take herbal supplements of any kind, as many patients don't consider these to be “medications” and will omit them during history. Of note, turmeric has to be taken with black pepper for better GI absorption.Weight reduction: A healthy diet and fitness are always recommended. Online guidelines are helpful on topics such as healthy fats, vegetables, avoiding refined sugar, and more. Obesity is a pro-inflammatory state, but it is important not to blame chronic pain problems solely on obesity since patients may still have pain after losing weight. Weight reduction can be a part of that plan, but we should not promise a cure for chronic pain after a patient reaches an ideal weight. Sleep disturbances: Ironically, sleep improves pain, but pain makes sleep more difficult. If patients complain of sleep disturbances, start with behavioral changes, including improved sleep hygiene (keep a regular sleep schedule, exercise regularly, don't use caffeine and caffeinated beverages, don't eat too late at night) and stimulus control (the bed should only be used for two things: sleep and sex, get out of bed if you can't sleep, wake up at the same time every day, and avoid bright screens before bedtime because they confuse your brain); cognitive behavioral therapy (deal with concerns or worries that may interfere with sleep). Treating sleep disturbance may have a positive effect on the treatment of chronic pain. Acupuncture: It involves the insertion of very thin needles through the skin at specific points on the body. Acupuncture is a key component of traditional Chinese medicine and can be considered in patients with chronic pain. There are significant difficulties in studying acupuncture, but randomized trials suggest that acupuncture and placebo may have similar efficacy, and both are superior to no treatment. Pharmacologic therapy – For patients with inadequate analgesia despite nonpharmacologic therapies, we add carefully selected multi-targeted pharmacological therapies based on the type of pain (i.e., nociceptive, neuropathic, central sensitization) For nociceptive pain, start with non-steroidal anti-inflammatory drugs (NSAIDs) while continuing non-pharmacologic treatments. If that doesn't work add a topical agent such as lidocaine, capsaicin, or topical NSAIDs. Consider opioid treatment if neither of those works. For neuropathic pain, start with antidepressants or antiepileptic drugs: tricyclic antidepressants, SNRIs, pregabalin, gabapentin, or carbamazepine in addition to non-pharmacologic therapy. If those medications do not provide relief of pain, then you can consider adding topical agents and then opioids after weighing the risk and benefits. Side effects can be viewed as harmful, but we can use them for our benefit.Opioids are reserved for people with moderate to severe pain who cannot function. Once you identify a treatment that works for the patient, follow-up visits should be continued to promote behavioral changes, monitor therapeutic response, and treat side effects. A pain contract should also be signed.Follow-up visits – Schedule follow-up visits to continue educating patients and their families and caregivers, to continue motivational interviewing, and to monitor improvement. Refer patients who are not making enough progress, such as not reaching goals of function and quality of life, to comprehensive pain programs that can use additional modalities such as injections.Bottom line: Non-pharmacologic options should be considered in the management of all patients with chronic pain. The main non-pharmacologic strategies include physical therapy, psychological therapy, and complementary and integrative therapy. Remember to treat sleep disturbances and obesity as part of your plan. Add pharmacologic agents such as NSAIDs, antidepressants, and anticonvulsants when non-pharmacologic therapies do not help the patient reach their goals. Consider opioids only in moderate to severe pain with loss of function. Opioid prescription is a complex topic that was addressed in episode 31 of this podcast, more than 2 years ago, it is time for an update. Stay tuned, we will talk about opioids soon.____________________________Conclusion: Now we conclude episode number 125, “Non-opioid Chronic Pain Management.” Non-pharmacologic therapy is proven to be effective in the treatment of chronic pain, especially physical therapy, psychological therapy, and some complementary therapy. Medications can be added to non-pharmacologic therapy, mainly NSAIDs, antidepressants, antiepileptic medications, and more. Opioids can be added in disabling chronic pain, but prescription needs to be done cautiously and watchfully. The treatment of chronic pain may be challenging and daunting at times, but fortunately, we have science to back us up with effective ways to help our patients. So, don't be discouraged and trust science! This week we thank Fiona Axelsson, Jesse Lamb, and Hector Arreaza. Audio editing 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:Tauben, David, Brett R Stacey, Approach to the management of chronic non-cancer pain in adults, UpToDate. Last updated on May 06, 2022. Accessed January 10, 2023. https://www.uptodate.com/contents/approach-to-the-management-of-chronic-non-cancer-pain-in-adults.Choosing Wisely Recommendations: Don't provide long-term opioid therapy for chronic non-cancer pain in the absence of clear and documented benefits to functional status and quality of life, American Family Physician, Collections 460, American Academy of Family Physician. Link: https://www.aafp.org/pubs/afp/collections/choosing-wisely/460.html.What is Mindfulness? Mindful.org. https://www.mindful.org/what-is-mindfulness/.Jahromi B, Pirvulescu I, Candido KD, Knezevic NN. Herbal Medicine for Pain Management: Efficacy and Drug Interactions. Pharmaceutics. 2021; 13(2):251. https://doi.org/10.3390/pharmaceutics13020251.Royalty-free music used for this episode: “Good Vibes - Fashionista." Downloaded on October 13, 2022, from https://www.videvo.net/

Why do we love? And how much does our culture shape the way we do so? In this episode, Ilari talks with Helen Fisher about the powers that drive and shape our romantic relationships. Ilari and Professor Fisher discuss: Is romantic love a modern invention? Is monogamy a social invention?  Do men care more about sex? Do women care more about romance? Why agriculture, especially with the plough, caused havoc in romantic relationships. Why divorces might be on the decline. A science-based guide for maintaining romantic relations (based on couples who are still in love after 25 years) Why (certain) antidepressants can kill the sex drive and blunt romantic love (to read more, see the end of the notes) How common is polygamy or polyandry? Where in the world do we find most "free love"? Why did homosexuality evolve? Names mentioned Irenäus Eibl-Eibesfeldt (as recounted by Alison Gopnik in her The Gardener and the Carpenter) Bill Jankowiak Robert Sternberg (see episode 7) Anderson Thompson Bertrand Russell  Technical terms and ethnic groups mentioned Ventral tegmental area VTA Hypothalamus Dopamine, testosterone, oxytocin, vasopressin, serotonine Monogamy (serial or lifelong; social or biological) Polygamy (several wives) and polyandry (several husbands)  Tlingit (the polyandrous Inuit society with wealthy women) Oneida community (in New York State) Dig Deeper Antidepressants: To read more about the possible effects of SSRIs on sex drive and romantic love, see Tocco and Brumbaugh (2019). Below is a list of possible alternatives 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). Polyamory: In the episode, Professor Fisher suggests that many Amazonian tribes have informal polyandry, i.e. women have many partners, albeit only one formal husband. However, there are non-academic sources suggesting that formalised polyandry is common in the Zo'é community in Amazon. For some of these photos of Zo'é and other Amazonian tribes, many of whom exhibit remarkably liberal attitudes to sex, see the recent Amazonia exhibition in the London Science Museum.

Authors Raj Desai and Steven Smith evaluated data for patients with stable hypertension and depression to determine whether the initiation of serotonin norepinephrine reuptake inhibitors had a similar risk of antihypertensive treatment intensification and major adverse cardiovascular events compared to initiation of SSRIs. The full text manuscript is available at: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2686.

Join Dr. Danielle Belardo and her expert of the week, clinical psychologist Dr. Jonathan Stea, for a highly requested and informative episode about all things mental health. With the rise of pseudo-psychology circulating on social media, Dr. Stea has been on a mission to drown out the mental health misinformation noise by amplifying scientific communication in a digestible, creative way. Tune in to hear how Dr. Stea answers some important questions surrounding depression, anxiety, and much more.    Danielle and Jonathan discuss:    What depression and anxiety are and how they are diagnosed   Evidence-based therapies to treat depression, anxiety, and other disorders  Pharmaceutical treatment options including SSRIs and SNRIs and their effectiveness  The impact of exercise on mental health     Jonathan N. Stea, Ph.D., R. Psych., is a registered and practicing clinical psychologist and Adjunct Assistant Professor at the University of Calgary. Clinically, he specializes in the assessment and treatment of concurrent addictive and psychiatric disorders. He is interested in topics related to science communication and health misinformation in popular media, especially with respect to addiction and mental health. He is a coalition member of Science Up First which distributes and amplifies best-in-class, science-informed content surrounding COVID-19 and the COVID-19 vaccine. He is the co-editor of the forthcoming book Investigating Psychology: Pseudoscience, Fringe Science, and Controversies out in 2023.    Thank you so much for taking the time to contribute to a generation that values fact over fiction! Be sure to rate, review, and follow on your favorite podcast app and let us know which not-so-wellness trend you'd like to hear debunked. Follow your host on Instagram @daniellebelardomd and the podcast @wellnessfactvsfiction. Follow Jonathan @jonathanstea and Science Up First @ScienceUpFirst. 

According to the American Academy of Family Physicians, there are more than 50 Cytochrome P450 enzymes but there are just 6 of them that metabolize about 90% of the drugs. One of the most significant ones is the CYP2D6. In an article on healio written by Dr. Jai Patel, he talks about CYP2D6 metabolizing many of the SSRIs, SNRIs and TCAs that are the treatment options for depression. The clearance of TCA's for example is 50-67% lowered in CYP2D6 poor metabolizers compared to normal. www.aafp.org/afp/2007/0801/p391.html  Pharmacogenetic testing may improve outcomes for patients with depression (healio.com) Kristine Ashcraft is a molecular biologist by training and is the former CEO and founder of YouScript which was recently acquired by Invitae. She has worked in pharmacogenomics space since 2000 and was recently named one of the 25 leading voices in precision medicine. Kristine has authored multiple publications on both the clinical and economic benefits of PGx testing. She serves on the Steering Committee of STRIPE which is the FDA collaborative community for PGx. She has been interviewed by numerous media including the New York Times, the Wall Street Journal, and NBC Nightly News and has spoken at American Society of Human Genetics, and numerous precision medicine conferences and now speaking at one of the top 20 genomics podcast in the globe, PGx for Pharmacist Podcast. Learn more about your ad choices. Visit megaphone.fm/adchoices

According to the American Academy of Family Physicians, there are more than 50 Cytochrome P450 enzymes but there are just 6 of them that metabolize about 90% of the drugs. One of the most significant ones is the CYP2D6. In an article on healio written by Dr. Jai Patel, he talks about CYP2D6 metabolizing many of the SSRIs, SNRIs and TCAs that are the treatment options for depression. The clearance of TCA's for example is 50-67% lowered in CYP2D6 poor metabolizers compared to normal. www.aafp.org/afp/2007/0801/p391.html  Pharmacogenetic testing may improve outcomes for patients with depression (healio.com) Kristine Ashcraft is a molecular biologist by training and is the former CEO and founder of YouScript which was recently acquired by Invitae. She has worked in pharmacogenomics space since 2000 and was recently named one of the 25 leading voices in precision medicine. Kristine has authored multiple publications on both the clinical and economic benefits of PGx testing. She serves on the Steering Committee of STRIPE which is the FDA collaborative community for PGx. She has been interviewed by numerous media including the New York Times, the Wall Street Journal, and NBC Nightly News and has spoken at American Society of Human Genetics, and numerous precision medicine conferences and now speaking at one of the top 20 genomics podcast in the globe, PGx for Pharmacist Podcast. Learn more about your ad choices. Visit megaphone.fm/adchoices

According to the American Academy of Family Physicians, there are more than 50 Cytochrome P450 enzymes but there are just 6 of them that metabolize about 90% of the drugs. One of the most significant ones is the CYP2D6. In an article on healio written by Dr. Jai Patel, he talks about CYP2D6 metabolizing many of the SSRIs, SNRIs and TCAs that are the treatment options for depression. The clearance of TCA's for example is 50-67% lowered in CYP2D6 poor metabolizers compared to normal. www.aafp.org/afp/2007/0801/p391.html  Pharmacogenetic testing may improve outcomes for patients with depression (healio.com) Kristine Ashcraft is a molecular biologist by training and is the former CEO and founder of YouScript which was recently acquired by Invitae. She has worked in pharmacogenomics space since 2000 and was recently named one of the 25 leading voices in precision medicine. Kristine has authored multiple publications on both the clinical and economic benefits of PGx testing. She serves on the Steering Committee of STRIPE which is the FDA collaborative community for PGx. She has been interviewed by numerous media including the New York Times, the Wall Street Journal, and NBC Nightly News and has spoken at American Society of Human Genetics, and numerous precision medicine conferences and now speaking at one of the top 20 genomics podcast in the globe, PGx for Pharmacist Podcast. Learn more about your ad choices. Visit megaphone.fm/adchoices

Which is the best antidepressant for combination treatment in psychotic depression? This episode includes the use of venlafaxine plus quetiapine and how to choose an antidepressant for combination treatment. Faculty: David Osser, M.D. Hosts: Jessica Diaz, M.D., Flavio Guzman, M.D. Learn more about Premium Membership here Earn 1.25 CMEs: The Psychopharmacology Algorithm for Psychotic Depression Node 2C: Combination Therapy: SNRIs + Antipsychotics  

Studies show that opioids are the number one prescribed medication for peripheral neuropathy contrary to evidence suggesting a lack of efficacy. Despite being a common condition for individuals with diabetes, treatment is often non-evidence based, meaning that creating a care plan can be difficult. With this, the American Academy of Neuropathy (AAN) was urged to re-evaluate treatment recommendations for Diabetic Neuropathy Pain (DNP). Listen in as Dr. John Swegle, a pain management expert, and host Geoff Wall discuss the updates on DNP treatment recommendations. The GameChanger:AAN guidelines reaffirmed that opioids should not be used in the treatment of DNPMore appropriate treatments for DNP would include gabapentinoids, TCAs, and SNRIsSNRI, especially venlafaxine dosing should be targeted to achieve the norepinephrine effects of the drug classFor patients wishing for natural therapy regimens, gingko may be considered Show Segments:00:00 – Introductions02:05 – The American Academy of Neuropathy Guideline Update05:29 – Treating and Controlling Diabetes06:27 – Comparing Gabapentinoids, Sodium Channel Blockers, SNRIs, Opioids, and TCAs12:30 – The GameChanger 19:29 – The American Academy of Neuropathy Recommendations24:49 – Closing Remarks Guest Bios:John Swegle, PharmD, BCPS, BCACP Clinical Associate Professor University of Iowa College of PharmacyJohn received his PharmD degree from the University of Iowa. He currently is a Clinical Associate Professor with the University of Iowa and clinical pharmacist with the Mercy Family Medicine Residency Program. In addition, he works with Hospice of North Iowa serving as a consultant pharmacist and as a faculty member for the Mercy Medical Center – North Iowa Palliative Medicine Fellowship.Links to Resources:American Academy of Neuropathy – Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update SummaryHealthcare Claim Study – Opioids in Peripheral Neuropathy How to Claim CECE is available for CEimpact members. Click here to claim CPE Credit Click here to claim  CME CreditNeed a membership?Join for CPE Credit Join for CME CreditLearning Objectives: 1. Select an appropriate first line medication for diabetic neuropathic pain (DNP) based on the 2022 guidelines2. Describe the treatment effects of the drugs used for DNP in the 2022 guidelinesDr. Wall is a member of the Janssen Speaker's Bureau. Dr. John Swegle reports no actual or potential conflicts of interest associated with this episode.Continuing Education Information:0.05 CEU | 0.5 HrsACPE UAN: 0107-0000-22-057-H01-PInitial release date: 01/03/22Expiration date: 01/03/2023Additional CPE & CME details can be found here.

From melatonin for sleep-onset insomnia to electroconvulsive therapy for severe adolescent mood disorder to steroid-induced psychosis to the risk of stimulant-induced psychosis in youth with ADHD, and MORE! In this two-part series, Mara and Dr. Feder will tackle various research topics in the field of child psychiatry. CME: Clinicians enrolled in our Podcast CME Subscription can access the post-test here.Published On: 12/9/2021Duration: 14 minutes, 35 secondsReferenced Articles: “Risk of Psychosis With Stimulants in ADHD Patients,” The Carlat Child Psychiatry Report, May/June/July/August 2021“Vitamin D for ADHD?,” The Carlat Child Psychiatry Report, October/November/December 2020“Efficacy and Safety of SSRIs and SNRIs for Child and Adolescent Psychiatric Disorders,” The Carlat Child Psychiatry Report, January/February 2018Joshua Feder, MD, and Mara Goverman, LCSW, have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

In the effort to prevent relapse in patients who have experienced depressive episodes, it has been common practice to have them continue long-term on antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs). In this author podcast, Giovanni A. Fava discusses his guest editorial that challenges that custom and suggests alternative approaches for preventing relapse. Dr. Fava's Guest Editorial is published in the November-December 2021 issue of the Journal of Clinical Psychopharmacology.

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Anticonvulsants, SNRIs, and rubefacients are best initial choices for chronic pain caused by diabetic neuropathy or postherpetic neuralgia '

In this Healthed lecture, Prof David Castle, Psychiatrist; Inaugural Scientific Director, Centre for Complex Interventions (CCI) at the Centre for Addictions and Mental Health (CAMH), Toronto, Canada;  Professor, Department of Psychiatry, The University of Toronto explains why mood disorders in men are less common than in women, but keep this diagnosis in mind if behaviour is becoming violent. Allowing men to express their emotional pain and marshalling support, offering helplines, support groups all help. Pay attention to longitudinal history when differentiating depression from bipolar disorder, and if you suspect this, avoid prescribing SNRIs and tricyclics. When the patient cannot see the pain they will cause when they die by suicide, we may have to take active measures even against the patient's will. See omnystudio.com/listener for privacy information.

Consider mood issues in men if behaviour is becoming violent. Allow men to express their emotional pain by marshalling support, offering helplines and recommending support groups When differentiating depression from bipolar disorder, keep longitudinal history in mind. If you suspect bipolar, avoid prescribing SNRIs and tricyclics When the patient cannot see the pain they will cause when they die by suicide, we may have to take active measures even against the patient's will   Host: Dr David Lim | Total time: 38 mins Guest: Prof David Castle, Psychiatrist; Inaugural Scientific Director, Centre for Complex Interventions (CCI) at the Centre for Addictions and Mental Health (CAMH), Toronto, Canada; Professor, Department of Psychiatry, The University of Toronto Register for our upcoming FREE WEBCAST! Tuesday 27 April 2021 | 7:00pm-9:00pm AEDT Click here to register now! See omnystudio.com/listener for privacy information.

Buddy talks about white paint, a present from his lady, local book stores vs BAM, almost failing a class because you can't give a fuck toward the end of the semester, SSRIs vs SNRIs, oversleeping, and sings the shit out of "Kiss From A Rose." Enjoy!  

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. 

Also ask yourself, did this study compare their treatment to the 'gold standard' and if the answer is no they compared it to a straw man, then think big Pharma, or authors that needed publication for their job. We can't treat what we don't know exist and 30-50% of the time COVID19 is asymptomatic. Combined Oral Contraception DO NOT have an increase risk of DVT and long term the risk are very minimal if a DVT does develop while on COC. Speaking of studies that should have never been done- Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study) | Gut (bmj.com) Diagnostic Yield of Colon Capsule Endoscopy vs CT Colonography in a Screening Population | PracticeUpdate The authors of this multicenter, prospective, randomized study compared the diagnostic yield of colon capsule endoscopy (CCE) with that of CT colonography (CTC) for colon cancer screening in an average-risk adult population. First you had either a CCE or a CTC and then the findings were confirmed with colonoscopy. The sensitivity and specificity of CCE for polyps ≥6 mm were 79.2% and 96.3%, respectively, compared with 26.8% and 98.9%, respectively, with CTC. The sensitivity and specificity of CCE for polyps ≥10 mm were 85.7% and 98.2%, respectively, compared with 50% and 99.1%, respectively, with CTC. They authors say this may work for people who refuse colonoscopy. Which is true it might but we have a fit test—it cost pennies—why in the world do we need this test?!? Its more money its more invasive its not better than FIT….. This is a study we didn’t need till I read the 30 line conflict of interest and I knew exactly why we needed this trial—to keep big pharm in business Colon cancer is scary cause most of the time we don’t know we have it and speaking of thigs we don’t know we have Asymptomatic SARS-CoV-2 Infections Among Persons Entering China From April 16 to October 12, 2020 | Global Health | JAMA | JAMA Network China controlled their cases because Beginning April 1, 2020, persons entering China via air, sea, or land have been mandatorily tested for SARS-CoV-2 infection by PCR test at border checkpoints. retrospective cohort study looked at All international entrants found to have SARS-CoV-2 infection via a positive PCR test result at China’s border checkpoints from April 16 to October 12 were included in this study. 3103 had confirmed COVID-19 cases, AMONG THOSE 1612 (51.9%) never developed symptoms through day 13 and were considered to have asymptomatic SARS-CoV-2 infection. The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org) Purpose: To estimate the proportion of persons infected with SARS-CoV-2 who never develop symptoms. And results found- about 1/3 of people had no symptoms and if you test positive and have no symptoms then about 75% of the time you will never have symptoms. WE will never be able to stop what we don’t even know about. WE can never and I repeat NEVER flatten a curve on something that you may not even know you have 33% of the time. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis | The BMJ Prescribe antidepressants for depression not for pain Design Systematic review and meta-analysis. Objective To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). Results 33 trials (5318 participants) were included. Back pain- serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89). tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89). SNRIs reduced disability from back pain at 1-13 weeks around 1-3 points—TO WHAT SIGNIFCANT CLINCALY ON 100 point scale. osteoarthritis- SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks TCAs and other antidepressants did not reduce pain or disability from back pain. ReplyForward 8000 women from 2004-2006- to be included you could not be pregnant or postpartum and aged ≤ 50 years, without active cancer There were 220 women had either a first distal dvt, first prox dvt, or a first PE Of these women, 47.3% (n/N = 104/220) were on COC pills at the time of their VTE event. Overall, 27.6% of patients developed venous thromboembolism (VTE)

Episode 38: Menopause Tips. Asthma treatment update, menopause tips, MMR associated fever and seizures.Today is January 25, 2021.Updates on asthma: As you know asthma is a significant burden for our healthcare system, and for the most part it is not preventable nor curable, but advances in management have changed many patient’s lives over the last 40 years. On our episode 27, we mentioned the updated practice guidelines by the Global Initiative of Asthma (GINA). Today we will give you the updated recommendations by the National Asthma Education and Prevention Program (NAEPP) posted on December 3, 2020. It contains recommendations for the treatment of asthma in children, adolescents, and adults[1]. This is an update from the NAEPP 2007 guidelines and are slightly different than GINA regarding step 1 and step 2 management.-Step 1 (intermittent asthma): NAEPP did not make any changes from 2007. They continue to recommend short-acting β2-agonists [SABAs] for rescue therapy. Remember that GINA recommends against use of SABA as a sole therapy for step 1. -Step 2 (mild persistent asthma): Either daily low-dose ICS plus as-needed SABA therapy or as-needed concomitant ICS and SABA. -Step 3 and step 4 (moderate persistent asthma): formoterol combined with an inhaled corticosteroid in a single inhaler (also known as single maintenance and reliever therapy – SMART) is recommended as the preferred therapy. For step 3 a LOW-dose ICS-formoterol therapy is recommended, and for step 4 a MEDIUM-dose ICS-formoterol therapy is recommended for both daily and as-needed therapy. A short-term increase in the ICS dose alone for worsening of asthma symptoms is not recommended. -Step 5 (severe persistent), adding a long-acting muscarinic antagonist (LAMA) is recommended in patients whose asthma is not controlled by ICS-formoterol therapy. -Fractional exhaled nitric oxide testing (FeNO) is recommended to ASSIST in diagnosis and monitoring of symptoms, but is should not be used ALONE for the diagnosis and monitoring of asthma, and do NOT use in younger than 5 yo patients. Another recommendation is to control allergens in patients with relevant sensitivity. This may not sound so new, but there are several strategies for allergen mitigation, for example, use of impermeable pillow and mattress covers only as part of a multicomponent allergen mitigation intervention. Subcutaneous immunotherapy is recommended as an adjunct to standard pharmacotherapy for individuals with symptoms and sensitization to specific allergens. Sublingual immunotherapy is not recommended specifically for asthma. Bronchial thermoplasty is not recommended as part of standard care; if used, it should be part of an ongoing research effort. If you are still confused about these 2020 NAEPP guidelines updates, I recommend you go online and review them, it is easier to read them than listening to them. Find the link in our posted script.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. ____________________________Menopause Tipsby Valerie, That's me, Dr. Civelli w/ a C!and your friendly medical student neighbor Patrick De LunaTIP #1: Hot Flashes. Hot flashes, aka vasomotor symptoms occur in 70% of women in menopause. Hot flashes can last 1-5 minutes; can be characterized by perspiration, flushing, chills, clamminess, anxiety, and on occasion, heart palpitations; and can cause sleep disturbances. Hot flashes are the most common indication for hormone replacement therapy (HRT). Contraindications for HRT include undiagnosed vaginal bleeding, a history of breast cancer, VTE, or Severe liver disease.Dr Wonderly, how do you treat hot flashes? [Listen to her answer in Episode 38]TIP #2: Hormonal replacement therapy for hot flashes.Estrogen or estrogen/progesterone combo is the most effective therapy for menopausal hot flashes. It’s FDA-approved and has a grade A research according to AAFP and ACOG. Topical methods are preferable as they have fewer adverse effects. But how do you choose? There’s Estrogen? Or estrogen/Progesterone combo? And what is the cancer risk? Remember if using hormones: Dose, duration and risk factors are key! Combined estrogen/progestogen therapy is recommended over estrogen alone, but still increases the risk of breast cancer after three to five years of use. There is no evidence that using low-dose local estrogen increases the risk of breast cancer recurrence. Combined formulation of estrogen and the selective estrogen receptor modulator bazedoxifene may also be used, especially when the patient still has a uterus. The decision to start HRT or to continue for more than three to five years should be made after reviewing all risks, benefits, and symptoms with each patient. Dr Wonderly, when do you decide to continue HRT for longer than 3-5 years? [Listen to her answer in Episode 38]TIP #3: Nonhormonal options to treat hot flashes.Vasomotor symptoms are best managed with systemic HT, but FDA approved, nonhormonal treatment options are available which are SSRIs, SNRIs, and clonidine. All have been shown to be effective. Antidepressants for nonhormonal treatment of vasomotor symptoms specifically include: citalopram, escitalopram, clonidine, desvenlafaxine, venlafaxine, gabapentin, pregabalin, and paroxetine. TIP #4: Natural remedies for menopause. There is no high-quality, consistent evidence that all-natural herbal alternatives are effective. This includes black cohosh, botanical products, omega-3 fatty acid supplements, or lifestyle modifications.  AAFP and ACOG do not endorse any of these as appropriate alternatives. For effective, evidenced based, proven therapies to alleviate hot flashes, think estrogen, estrogen/progesterone combo or antidepressants. TIP #5: The “timing hypothesis” in HRT? It is possible that a patient may ask you about your opinion regarding the timing hypothesis. This hypothesis suggests that starting hormone therapy early in menopause (compared with starting it 10 years or more after the onset of menopause) may be cardioprotective because of estrogen's apparent ability to slow the progression of atherosclerosis in younger women.  Although the evidence suggests that beginning hormone therapy near the start of menopause decreases the risk of cardiac disease, further study is needed. Current guidelines recommend against using hormone therapy to prevent or treat cardiac disease. Further, the American Academy of Family Physicians recommends against using hormone therapy for the prevention of chronic conditions. Dr Wonderly, when is the ideal time to start HRT? [Listen to her answer in Episode 38]TIP # 6: Genitourinary syndrome in menopause (GSM). In 2014, a consensus conference endorsed new terminology: the term genitourinary syndrome of menopause is now recommended to use and replaces the terms vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. Keep in mind this change is because new terminology accounts for the genital tract symptoms that commonly occur in women with menopause.Genitourinary Syndrome of Menopause (GSM) is a chronic, progressive, vulvovaginal, sexual, and lower urinary tract condition characterized by a broad spectrum of signs and symptoms due to the lack of estrogen that characterizes menopause. Even though the condition mainly affects postmenopausal women, it is seen in many premenopausal women as well. The low estrogen level causes structural changes such as vaginal dryness, dyspareunia, and reduced lubrication. These can have a great impact on patients’ quality of life.Treatment: Women with GU syndrome in menopause may benefit from vaginal estrogen, nonhormonal vaginal moisturizers, or ospemifene (the only nonhormonal treatment approved for dyspareunia due to menopausal atrophy). Dr Wonderly, do you think UTIs are commonly misdiagnosed in menopause when the GU symptoms are actually being caused by low estrogen? [Listen to her answer in Episode 38]TIP #7: The MenoPro® app.This app has several unique features, including the ability to calculate your 10-year risk of heart disease and stroke, which is important in deciding whether a treatment option is safe for you. It also has links to online tools that assess your risk of breast cancer and osteoporosis and fracture[7].Dr Wonderly, do you know any comprehensive app to be used in menopause? [Listen to her answer in Episode 38]Conclusion: Menopause is likely undertreated because patients suffer in silence and do not disclose their symptoms to the doctor because these symptoms are seeing as “normal part of life” and lack of treatment is not fatal, but treatment can improve quality of life significantly. So, be aware of these symptoms and be prepared to treat them appropriately. Estrogen Medications for the Treatment of Vasomotor SymptomsMEDICATIONAVAILABLE DOSAGES (MG)BIOIDENTICAL?COST*OralEnjuvia (conjugated estrogen)0.3, 0.45, 0.625, 0.9, 1.25 (per day)No$87Estrace (estradiol)0.5, 1.0, 2.0 (per day)Yes$131Menest (esterified estrogen)0.3, 0.625, 1.25, 2.5 (per day)No$48Premarin (conjugated estrogen)0.3, 0.45, 0.625, 0.9, 1.25 (per day)No$143Transdermal patch (estradiol)Alora0.025, 0.05, 0.075, 0.1 (twice per week)Yes$90Climara0.025, 0.0375, 0.05, 0.06, 0.075, 0.1 (once per week)Yes$50Minivelle0.025, 0.0375, 0.05, 0.075, 0.1 (twice per week)Yes$137Vivelle Dot0.025, 0.0375, 0.05, 0.075, 0.1 (twice per week)Yes$84Transdermal gel (estradiol)Divigel0.25, 0.5, 1.0 (per day)Yes$118Elestrin0.52 (per day; adjust dosage based on response)Yes$109Estrogel0.75 (per day)Yes$126Transdermal spray (estradiol)Evamist1.53 per spray (start with 1 spray per day, adjust up to 3 sprays per day based on response)Yes$118Vaginal (estradiol)Femring0.05, 0.10 (for 90 days)Yes$355*—Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com(accessed June 13, 2016).   ____________________________Speaking Medical: MMR by Heather Langner, MS4MMR is a vaccine against measles, mumps, and rubella which contains live attenuated viruses. In the US, children should get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 through 6 years of age (usually before starting preschool or kindergarten).  MMRV (MMR combined with varicella, brand name ProQuad) has been proposed as a way to simplify administration. Let’s listen to what our future doctor has to say about it[8].According to the CDC there are 2 adverse events that occur most often during the 42 days after the first dose of the MMR/MMRV vaccine: Fever of 102F or higher and rash. The highest rates happening between 5-12 days after vaccination. Risk of fever: When the MMR vaccine and the Varicella vaccine are given separately the risk of fever (above 102F) is slightly higher than when given the combined MMRV vaccine (1 in 7 vs 1 in 5 children). Risk of seizures: A study published in Pediatrics explored the risk of febrile seizures in the MMR vs MMRV vaccine. The study included over 83,000 MMRV vaccine recipients and over 376,000 MMR+V vaccine recipients. The study found that the fever and seizures were clustered around day 7-10. The MMR+V vaccine had a febrile seizure risk of 4 in 10,000 doses and the MMRV vaccine had 5 in 10,000 doses. So, the risk of seizures is slightly higher when MMR and varicella are given combined (MMRV).After first dose: Data suggests febrile seizure post MMR vaccination are primarily seen after the first dose in children aged 12-47 months. The second dose of the vaccine is less likely to cause fever than the first dose. This means that having a febrile seizure after the first vaccination is not a contraindication for receiving subsequent doses. Something to consider: if there is a personal or family history (parent or sibling) of febrile seizures, the child should receive the separate MMR and Varicella vaccine. As children get older the risks for the MMR vs MMRV vaccine are the same.Contraindications: Per the AAP the only absolute contraindications for the MMR or MMRV vaccine: anaphylactic reaction to MMR vaccine or its components (neomycin or gelatin), pregnancy, and immunosuppression. Relative contraindications include: history of thrombocytopenia (small risk for thrombocytopenia post vaccination, but no hemorrhagic complications have been reported), recent receipt of blood products (may interfere with seroconversion), patients receiving high-dose steroid therapy (immunosuppression), and severe acute illness (precaution intended to prevent complicating management with vaccine reactions). Egg allergy reactions to the MMR vaccine are now considered extremely rare and is therefore no longer a contraindication. Breastfeeding and fevers are also not contraindications for MMR vaccine administration.__________________________Question of the month: Diabetes managementby Steven Saito, MD This is a reminder of our question for this month. Please answer before Feb 8, 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.____________________________For your Sanity: Random Jokesby Katherine Schlaerth, Manuel Tu, and Cassandra Levitske-If those who can’t hear are deaf, and those who can’t see are blind, what do you call those who can’t smell or taste?-Covid positive-What does a gynecologist and a deaf person have in common? They're pretty good at reading lips.-Why did Tigger stick his head in the toilet?-He was looking for Pooh.-Why is pea soup more special than mashed potatoes?-Because anyone can mash potatoes.Conclusion: Now we conclude our episode number 38 “Menopause Tips”, we started with some updates on asthma management, then Dr Civelli and our “future doctor” De Luna gave us some tips about the treatment of menopause symptoms. Our wonderful Dr Wonderly also answered a few questions about the management of this unavoidable, “period-free” period in a woman’s life. Then doctor-to-be Heather explained her findings on risks associated with MMR, specifically fever and seizure risks. Don’t forget our question for this month. Send us a brief, original, and relevant answer to our email before Feb 8, 2021. We hope you enjoyed this episode.  Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email 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, Valerie Civelli, Patrick De Luna, Sally Wonderly, Cassandra Levitske, Manuel Tu, Katherine Schlaerth, Tana Parker, and Steven Saito. Audio edition: Suraj Amrutia. See you next week! _____________________References:Cloutier MM, Dixon AE, Krishnan JA, Lemanske RF, Pace W, Schatz M. Managing Asthma in Adolescents and Adults: 2020 Asthma Guideline Update From the National Asthma Education and Prevention Program. JAMA. 2020;324(22):2301–2317. doi:10.1001/jama.2020.21974 (https://jamanetwork.com/journals/jama/article-abstract/2773482)2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group, https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/2020-focused-updates-asthma-management-guidelines. Asthma: Updated Diagnosis and Management Recommendations from GINA, Am Fam Physician. 2020 Jun 15;101(12): 762-763. https://www.aafp.org/afp/2020/0615/p762.html.  Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2020. Available from: www.ginasthma.orgACOG Releases Clinical Guidelines on Management of Menopausal Symptoms, Am Fam Physician. 2014 Sep 1;90(5):338-340. https://www.aafp.org/afp/2014/0901/p338.htmlHormone Therapy and Other Treatments for Symptoms of Menopause. Am Fam Physician. 2016 Dec 1;94(11):884-889. https://www.aafp.org/afp/2016/1201/p884.htmlHabib, Jamie, NAMS Launches Free Mobile Menopause App, Contemporary OB/GYN, October 16, 2014, https://www.contemporaryobgyn.net/view/nams-launches-free-mobile-menopause-appDavid W. Kimberlin, ACIP, AAP support choice of MMRV or separate MMR, varicella vaccines, AAP News January 2010, 31 (1) 10; DOI: https://doi.org/10.1542/aapnews.2010311-10. https://www.aappublications.org/content/31/1/10.1Meissner, H. Cody, MD, FAAP, What are the indications, precautions, contraindications for MMR vaccination?AAP News, May 14, 2019, https://www.aappublications.org/news/2019/05/14/idsnapshot051419.  Febrile Seizures and Childhood Vaccines, Questions and Concerns, Centers for Disease Control and Prevention, last reviewed on August 14, 2020, https://www.cdc.gov/vaccinesafety/concerns/febrile-seizures.html.MMRV Vaccine and Febrile Seizures, Centers for Disease Control and Prevention, last reviewed on June 4, 2020, https://www.cdc.gov/vaccinesafety/vaccines/mmrv/mmrv-febrile-seizures.html.VSD MMRV Safety Study, Centers for Disease Control and Prevention, last reviewed on June 29, 2020, https://www.cdc.gov/vaccinesafety/vaccines/mmrv/vsd-mmrv-safety-study.html.Klein Nicola P., Bruce Fireman, W. Katherine Yih et al, Measles-Mumps-Rubella-Varicella Combination Vaccine and the Risk of Febrile Seizures, Pediatrics, July 2010, 126 (1) e1-e8; DOI: https://doi.org/10.1542/peds.2010-0665. https://pediatrics.aappublications.org/content/126/1/e1.

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.

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.

Practice Bulletins #218 - Published March 2020 1. Up to 33% of women with chronic pelvic pain will also meet criteria for diagnosis of major depression 2. An interdisciplinary approach is the way go to: gynecologist, physical therapist, and psychologist in the very least. 3. The physical exam should be approached very carefully and systematically 4. Yoga, acupuncture, and other complementary and integrative therapies should absolutely be considered. 5. Don't prescribe opioids for chronic pelvic pain. Go with neuropathic agents, SNRIs, and tricyclic antidepressants. Show Notes **Visit our friends at www.intimatewellnessshop.com for bushels of sex positivity, including toys, massage oils, self-care products, and more! Use code MOREWINE at checkout for 15% off your purchase!** Wine pairing: 2017 Red Blend from Francis Coppola Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Dr. Ben Malcolm completed a Doctorate in Pharmacy and a Masters in Public Health, prior to post-graduate training and board-certification in psychiatric pharmacy. He currently holds a position in academia teaching psychiatric pharmacy, as well as providing consulting services for those seeking information about psychedelics at SpiritPharmacist.com. In this episode, Dr. Malcolm discusses how antidepressants react with MDMA, psilocybin, DMT, 5-MeO-DMT, ayahuasca, and ketamine. He also explains the risk profiles for interactions between psychedelics and medications such as benzodiazepines, sleep medication, antipsychotics, and lithium.   In this episode: Why combining antidepressants with ayahuasca has a high physical risk profile. How antidepressants can diminish the effect of MDMA and why it is advised to not take a high dose of MDMA to attempt to workaround that effect. What serotonin syndrome is and how to avoid it. How one’s use of antipsychotics or lithium may be an indicator of possible contraindicated condition to psychedelic use. Quotes: “[A]ntidepressants like the SSRIs or SNRIs, in the long-term, create changes that makes the brain more resistant to using a psychedelic like MDMA”  [9:14] “Most available and most antidepressant-friendly is [...] ketamine” [20:00] “With microdoses, you’re talking about using very very small doses, and you’re probably not talking about using something like MDMA that depletes serotonin. You’re probably talking about using psilocybin or LSD, and so for those, the drugs have great physical safety profiles in very very large doses. So if you’re thinking if there’s going to be some horrible interaction risk that kind of pops out of the closet with psilocybin or LSD with my antidepressant? Probably not.” [46:00] Links: Spirit Pharmacist Website  Psychedelic School - Courses on pharmacology, safe use and integration Erowid Porangui Get 20% off everything at Octagon Biolabs with coupon code 'plantmedicine'

Since 2006 the FDA has listed a warning that using triptans with SSRIs and SNRIs can cause Serotonin Syndrome.  Tune in for my discussion of this.

In episode 449, Mike and James invite Danielle Perry and Joey Ton to go over our osteoarthritis systematic review. We talk about all the evidence around exercise, steroid injections, SNRIs, oral NSAIDs, glucosamine, topical NSAIDs, chondroitin, viscosupplementation, oral opioids, acetaminophen.

I don't know about you but I can't think of anything better than learning about the dynamic art of burlesque for curing seasonal affective disorder except maybe a strong course of SNRIs. Enjoy my chat with Remy Dee and find out a little bit more about the world and the people in it in 20 minutes or less. --- Support this podcast: https://anchor.fm/curiousqueen/support

We have all probably heard or read about how antidepressants can cause sexual dysfunction such as decreased libido, erectile dysfunction, decreased response to sexual stimuli, and delayed or absent orgasm. Given how widespread the use of antidepressants are, you may have personal experience with an antidepressant affecting your sexual function. What you may not know is that research consistently finds that sexual dysfunction continues in the majority of people even after they stop taking the medication. This is known as Post SSRI Sexual Dysfunction, or PSSD.  Less frequently, another form of sexual dysfunction may continue to manifest even after discontinuation of the medication: Persistent Genital Arousal Disorder (PGAD). This is essentially the opposite of PSSD, with PGAD causing a relentless sense of arousal and discomfort in the genitals, but without any accompanying feeling of desire.  So this is what can happen to adults. What happens when children are given antidepressants, right through their puberty? How does it affect their sexual function? In this episode I interview Daryl Brown about his experience with the mental health care system when he started to be medicated with antidepressants when he was 9 years old - even though he wasn’t depressed - and medicated with antipsychotics, even though he wasn’t having psychosis.  Daryl shares how it has affected his sexual function, and by extension his sense of self and his intimate relationships. Daryl asks the tough questions of the medical system: How could he, a mere child, have been given multiple medications - for over a decade - that provided no benefit, only harm? And how is that doctors continue to deny antidepressants can cause sexual dysfunction after they have been discontinued, in spite of research and patient reports confirming the harm? SHOW NOTES OCD and Tourette's syndrome 0:07:15 Daryl grew up in a suburb of London (United Kingdom) with 2 good parents, they are not together, but lucky to have them - a mix of nature and the city - 2 older siblings, 1 younger sibling 0:08:15 But missed a lot of family time due to mental health issues and hospitals - and his behaviour changed on the psychiatric drugs - and he went to special needs school far away - Daryl had some movement disorder and phobias since he was a baby 0:09:15 His brother noticed Daryl had strange movements as a baby and told others that Daryl had Tourette's Syndrome before he was diagnosed - Daryl got much sicker when he was about 9 years old, his OCD (obsessive compulsive disorder) and Tourette's got disabling worse 0:10:15 Daryl OCD caused him to spin around, and do repetitive rituals in a particular way - if it didn't feel like it went right, he would have to start the ritual over again - when it got really bad it was life consuming - he lost a lot of sleep worrying - a common feature 0:11:15 OCD symptoms was frustrating for Daryl, when it got out of control - Tourette's manifested has a lot of arm movements, leg movements, constantly parts of his body moving, even if people couldn't see what was happening with his toes and fingers, known has motor tics - Daryl also had a vocal tic of clearing his throat and making a weird noise 0:13:15 When Daryl's OCD and Tourette's got really bad, it was hard to live with the symptoms, but when mild they felt like a normal part of Daryl's life - for Daryl, only when its a the extremes does is it bothersome, and that may sound strange to some people - it doesn't interfere too much 0:14:15 Daryl remembers that his school was pushed around his phobias - other kids were yelled at, Daryl was yelled at when he coloured outside the lines - he was constantly being punished and he got scared at the way the other children were shouted at as well - they pushed him really hard about his phobias, and he tried really hard to break through and he did, but it was very hard - it all became very stressful and made everything a lot worse - at one point he ran away from school 0:15:15 The OCD and Tourette's was interfering with Daryl's ability to get dressed for school and it was all a stress on his Mom as she had to go to work - as Daryl got sicker, she called the local GP and child psychiatrist and they started prescribing medications - Daryl was only 9 years old 0:16:15 The child psychiatrist was convinced Daryl had OCD and brought an orange sugary liquid for Daryl to drink - it glowed in the dark - turns out the orange drink contained an SSRI (selective serotonin reuptake inhibitor - an anti depressant) - though Daryl didn't have depression - NICE (the UK's National Institute for Health and Care Excellence) guidelines said antidepressants are the standard treatment for OCD Antidepressants and antipsychotics 0:18:15 Daryl doesn't remember the effects of it, other than it tasted good because of the sugar and it had a cool colour - but it had no effect on his symptoms - because he was so sick he missed some school, so they visited a children's mental hospital 0:19:15 They said he needed to come in straight away - it was a diagnostic hospital, so children would be there for a year, there would be cameras watching them, and meeting with psychiatrists and psychologists and everyone in between - there was also a school so Daryl got some form of education - they put Daryl on anti-psychotic medications for the Tourette's Syndrome, also according to NICE guidelines - even though Daryl didn't have psychosis - so they are giving him both antidepressants and antipsychotics 0:20:15 The antipsychotics had no positive effect on his Tourette's, they just made his movements even more tiring on his body and upsetting - after a few months, his symptoms died down a little bit because some normality to his environment had returned and he was around other children - not because of the medications 0:21:15 Daryl's body also got used to the mixture medications, so he started to feel less tired - but he put on a lot of weight, when historically he was impossible for him to gain excess weight - Daryl also started to experience cravings, but he didn't feel in control of his actions and his emotions were all over the place, which is not like Daryl - crying one minute, angry the next, arguing with everyone, but didn't know why he was arguing but couldn't stop himself 0:22:15 It was frightening and confusing - after 9 months they confirmed diagnosis of OCD and Tourette's Syndrome - Daryl was recommended to go to a special needs school, but it was the middle of the school year and it was a nightmare to find a school - they did find one very far away, but that meant Daryl was not part of his home community 0:23:15 Daryl also continued treatment in a center that specialized in OCD and Tourette's in children and adolescents in south London - but that was also very far from where Daryl lived, so he had to go to that center and then school, and it was too much traveling and stress - and Daryl wouldn't say there was any real treatment - they expected Daryl to continue to take the antidepressants and antipsychotics, there was no plan to come off of them - it was expected that Daryl take them, no questions asked 0:24:15 Living away and going to another school was hard - if Daryl was strange to the other children in the community before, he was a lot more strange when he was removed - he would get teased in the street, and that got worse 0:25:15 Daryl really missed out on any thing in the community and didn't have a social life or a normal childhood - he was a normal intelligent child and wanted to do what every body else was doing - he did get to go home on weekends - the treatment center maybe helped with some of the phobias Daryl had Seizures. Brain Tumour? 0:26:15 Daryl stopped going to the after school day center after about 2 years - but there was no plan to stop the medication - sometimes there were promises that maybe one day in the future if their treatment miraculously works, he might be able to stop the meds - but there was no realistic plan to stop them, even when he stopped going 0:27:15 Daryl continued on the medication until he was living on his own and was 21 years old - Daryl had some seizures and passed out a couple of times - he didn't know yet it was from the medications - Daryl just attributed the new symptoms to OCD and Tourette's 0:28:15 Even though it was a special needs school, Daryl joined the football (soccer to North Americans) team and started to lose the excess weight - but it was hard to run, he was wheezing, because of the medications - but it was good to play football for the short periods he could - because the meds changed Daryl's behaviour so much, he was always arguing and he wasn't the same person - their only explanation was that Daryl had mental illness - as a result, Daryl lost contact and relationships with his siblings 0:29:15 The medications also blunted Daryl's impulsivity - he ran into traffic once - Daryl knows that he did not think that way before the meds, or since he stopped the meds - another time he took all his meds at once, not to kill himself, but because he couldn't stop the impulse 0:30:15 When Daryl was 21 years old he got very, very sick - and his erections stopped working properly - his penis wouldn't respond as it previously had with women - nor was he having the spontaneous erections like other young men 0:31:15 That was very scary - Daryl looked at the leaflets for the medications and saw sexual dysfunction far down the list - he went to the psychiatrist and he said it was probably the medications, we know about this, go off the medications and every thing will go back to normal - he just had to get a blood test to check on things - the results showed that Daryl's prolactin was through the roof - and wouldn't go down for a long time and they said that was impossible, 'nobody's prolactin stays that high' 0:32:15 They thought maybe it was a brain tumour causing high prolactin, but didn't really elaborate and left Daryl thinking he may have a brain tumour and wondering how long he has to live - but it wasn't a brain tumour, his prolactin levels normalized but his thyroid was messed up - eventually his blood tests normalized but the symptoms didn't go away and his 'willy' never went back to normal - the doctors kept fobbing him off, 'sometimes it takes a couple of weeks' - 'sometimes a couple of months' - then they said it was impossible because the drug had completely left his system and it had nothing to do with them Withdrawal weirdness 0:33:15 Then they started to say it was caused by a mental illness - the withdrawal actually caused a weird psychosis, deluded and confused thinking and weird adrenaline, all sorts of symptoms like brain zaps, even to his genitals when they were over-sensitized during withdrawal, like when he ejaculated when he was shopping, it is known as PGAD - Persistent General Arousal Disorder - and this is known to happen temporarily during withdrawal - but at 21 Daryl knew this was not normal 0:34:15 But the doctors and psychiatrists didn't believe in that, but Daryl knew full well what was going on and wondered how little did they know? - he looked up on the internet the medications he was on - they had added another med, Lyrica, to his antidepressant and antipsychotic, and the doctors touted how is was a 'wonder drug' and 'amazing' 0:35:15 Who knows how many other people they've given it to - its classified as a class 3 drug now, a street drug - Daryl never had an apology for that either - so he had to withdraw from all of those meds - they don't know how these meds work, even the drug companies don't know how or why - Daryl felt fear realizing for the 1st time how little these psychiatrists and psychologists really knew 0:36:15 The anxiety caused by withdrawal was a lot to deal with - also brain zaps, a full body 'electric shock sensations' during withdrawal as described in the NICE guidelines - Daryl started by tapering off the medications by cutting up the pills, but at 21 and his dick not working, and realizing the so-called experts didn't know much, was very scary and he wasn't going to keep taking them - he completely stopped taking them after about 4 weeks because they were making his dick numb and not work 0:38:15 Daryl wanted to know who did this to him and why - he felt targeted in that they were giving a child with disabilities medications that they did not know how it would affect him, its really abusive and he didn't feel like he was safe - and it is very lucrative for these pharmaceutical industries and in reality it is very dangerous and nobody stepped in any where 0:39:15 When Daryl was off the medications, there was no change in his OCD or Tourette's symptoms - there was no need to take these substances - Daryl says you would think they would have questioned that 0:40:15 Daryl advocates for safety measures to be taken and joined the Everyday Psych Victims Project and he's interviewed a few people who've been through the mental health system to give them and himself a voice - there is a 'side effect' charity with some psychiatrists and psychopharmacologists that know about this and have read the research, they're called Rxisk http://www.rxisk.org/ - and they are very aware of the permanent sexual side effects of antidepressants Brain Zaps and a Marathon 0:41:15 Both SSRIs and SNRIs - they've started a campaign to raise money and awareness - so Daryl signed up for a marathon to raise money and awareness for them - but it is hard to ask people to give money because your dick doesn't work - and it is not a mainstream charity, and some people won't donate for that reason - but Daryl followed through and did the marathon even though he missed all the training due to injury, but managed to finish somehow 0:42:15 Daryl has always liked sport, football, exercise - during withdrawal needed to distract from the horrible physical symptoms, and one of the ways to deal with that was to go for a run - doing sprints especially helped to manage his adrenaline - however, it felt like his life plans had been thrown out the window and he was very upset about what had been done to his genitals 0:43:15 But it doesn't just affect his genitals, it affected everything, how he felt and related to the world, especially at that age - so he focused on sport as a distraction, and that gave him some experience for the marathon, but he only played football twice about 2 weeks before the marathon - he ran until about half way then started walking and the last 10 kms was painful and a 6 hour finish time 0:44:15 Daryl tried to train through the injury as much as he could, but it came to a point where he was doing more damage - but he was determined to show up at the start line 0:45:15 He thought he would walk it, but when you line up at the start line you run with everyone else and he just tried to keep going - the music, crowds and kids cheering so he kept going as far as he could 0:46:15 With the brain zaps, his dick not working properly, or ejaculating sporadically, and pain in stomach - and that has not gone away, there is not a day that he is not constipated - Daryl had been medicated for over a decade, all through puberty 0:47:15 It impacted his emotions, angry one minute, sad the next, hyper the next - impeded his ability to think - he had to untangle his delusions and illusions - the adrenaline and emotions were all over the place and exercise even those out a bit - Daryl will turn 30 soon 0:48:15 In his early 20s it was extremely difficult to socialize, he felt like an alien, and he didn't want to do those things like flirting - it was horrible to be the only one in the world in that situation0:49:15He didn't think he'd ever socialize again, he wondered what planet he was living on - there is less pressure now to be flirtatious, so its a little easier - but he still often feels terrible when he compares himself to other people - so it still affects him a lot, but less so Post SSRI Sexual Dysfunction 0:50:15 Daryl still has quite a lot of pain, the stomach pain can be quite nasty - he does part-time work and volunteering, but the social part of his life is always missing - he has a leg injury from 2 years ago and still no diagnosis and he's limping very badly, he barely made it down stairs this morning, and this is after having hip surgery - there is talk of a hip replacement and pain killers but not sure what will happen with that 0:51:15 His hip and leg problems could be due to pressure from his bowels, he doesn't really know - and there has not been much research on side effects of psychiatric drugs - and he's been put off seeing doctors 0:52:15 Daryl likes watching football, but would rather be playing - he likes writing songs on his guitar and going for a jog - so exercise is a big part of self care and he's not sure what he'll do if his leg doesn't get better - though it hurts a lot to play guitar 0:53:15 Daryl has a couple of good friends that he could tell what has happened to him and they still liked him as a human being and that helped a lot because he felt he wasn't interested in flirting any more - some people thought he was going through a strange weird period, or was dealing with trauma, and that pushed people away as well 0:54:15 Daryl was wary to be public about his experience, set up a website and did a couple of videos, and started telling people in his life as well, to share his experience 0:55:15 There was no outpatient groups for adults, and they weren't allowed to socialize with other patients outside the hospital or clinics - one of their concerns is they don't want patients to meet, and they don't want patients to talk about their experiences with medications - Daryl thought he was the only one having this side effect and was on his own, and wasn't allowed to talk to the others to see if they also had this side effect - it is called Post SSRI Sexual Dysfunction (PSSD) 0:56:15 It means that the sexual side effects of SSRIs continue even after you stop taking them - he discovered others on the internet and that's when he decided to do something about it, since keeping it a secret wasn't working so well - it felt good to know there was other people, and that he was doing something about it - he also found other people that had bad experiences in the mental health system as well like Speak Out Against Psychiatry, Friends of East London Loonies, and The Every Day Psych Project 0:57:15 Daryl doesn't want this to happen to any one else, and the lack of regulation - it is criminal except they've got themselves covered legally - there is no reason except bank balances and careers that are set up on misinformation and secrecy and it needs to stop - and Daryl deserves validation that itactually happened instead of living his whole life with some imaginary thing that isn't happening Doctor Denial of PSSD 0:58:15 When he was a child, being around other children also going through similar experiences was good, but the drugs were not necessary 0:59:15 The school could have been more accommodating to a child instead of being so aggressive when that child wasn't exactly how they wanted them to be - but the staff were nice - he was scared before going in that the staff would be in white coats and do weird experiments on him, which they did, but not that they were collecting the data on their experiments - the staff were nice and well meaning, but obviously somebody should have intervened and stopped them from drugging every one into oblivion 1:00:15 His relationships now with his parents is good, but its taken a chunk out his life - when Daryl told his Dad about PSSD, his father said he was worried this would happen - his Mom was upset to, she was lied to and told the meds were safe - but the doctors insist that there can't be any permanent harm once the meds are out of the system - there is no risk, 'there's nothing to lose' as they say 1:01:15 They try to convince any one in his life that Daryl is mad and its not real - and they tried to turn his family against him and not to believe him - so its obviously very upsetting to go through - when Daryl was going through withdrawal he was paranoid so it was difficult to speak to his Mom and Dad - and he missed out a lot of life with his siblings 1:02:15 Daryl feels like his OCD and Tourette's symptoms are part of him, and they are not always at their worse - so its not the worse thing in the world - Daryl has hunch, in listening to other parents, that vaccines as babies may be causing tics and stuff - but there is a lack of research on vaccinations as well Connect with Daryl Brown: Twitter: @RunAgainstCastr Daryl's blog: PSSDblog Daryl's marathon campaign Info about Post-SSRI Sexual Dysfunction: Rxisk The Everyday Psych Victims Project - Their YouTube and Twitter __________________________________________________________________________ Be a podcast patron Support Medical Error Interviews on Patreon by becoming a Patron for $2 / month for audio versions.  Premium Patrons get access to video versions of podcasts for $5 / month. Be my Guest I am always looking for guests to share their medical error experiences so we help bring awareness and make patients safer. If you are a survivor, a victim’s surviving family member, a health care worker, advocate, researcher or policy maker and you would like to share your experiences, please send me an email with a brief description:  RemediesPodcast@gmail.com  Need a Counsellor? Like me, many of my clients at Remedies Counseling have experienced the often devastating effects of medical error. If you need a counsellor for your experience with medical error, or living with a chronic illness(es), I offer online video counseling appointments. **For my health and life balance, I limit my number of counseling clients.**  Email me to learn more or book an appointment:  RemediesOnlineCounseling@gmail.com Scott Simpson: Counsellor + Patient Advocate + (former) Triathlete I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard. Train hard. Rest hard. I have been living with HIV since 1998. I was the first person living with HIV to compete at the triathlon world championships.Thanks to research and access to medications, HIV is not a problem in my life. I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life. Counseling / Research I first became aware of the ubiquitousness of medical error during a decade of community based research working with the HIV Prevention Lab at Ryerson University, where I co-authored two research papers on a counseling intervention for people living with HIV, here and here.  Patient participants would often report varying degrees of medical neglect, error and harms as part of their counseling sessions. Patient Advocacy I am co-founder of the ME patient advocacy non-profit Millions Missing Canada, and on the Executive Committee of the Interdisciplinary Canadian Collaborative Myalgic Encephalomyelitis Research Network. I am also a patient advisor for Health Quality Ontario’s Patient and Family Advisory Council, and member of Patients for Patient Safety Canada. Medical Error Interviews podcast and vidcast emerged to give voice to victims, witnesses and participants in this hidden epidemic so we can create change toward a safer health care system. My golden retriever Gladys is a constant source of love and joy. I hope to be well enough again one day to race triathlons again. Or even shovel the snow off the sidewalk. Remedies Counseling - Making Life Better Have you had traumatic experiences with the health care system? Are you living / struggling with a chronic illness? Do you need a counsellor with proven expertise and experience to make life better? Book an appointment with me at RemediesOnlineCounseling@gmail.com    

Ruta Nonacs, MD, PhD, conducts a Masterclass lecture on treating women with postpartum depression from the Psychopharmacology Update in Cincinnati. The meeting was sponsored by Global Academy for Medical Education and Current Psychiatry. Dr. Nonacs is a staff psychiatrist with the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital in Boston.  *  *  *   Help us make this podcast better! Please take this short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *  *  *   Features of postpartum depression  Postpartum depression (PPD) affects 10%-15% of women after delivery. For many women, their depression starts in the third trimester and worsens after delivery. Unique symptoms of PPD include difficulties bonding with the baby, feeling like an inadequate mother, and experiencing severe sleep disturbance with anxiety and edginess. In a common scenario, the mother will not be able to sleep at night, though her baby is sleeping well. Anxiety is a common comorbidity, especially obsessive thoughts about the baby’s safety. Treatment of PPD Treatment in this population is complicated by many demands placed on a mother as the primary caregiver of an infant. The medication chosen must target depression and anxiety, improve sleep, yet not be too sedating. The concentration of antidepressants in breast milk is low, but many women will defer treatment for their depression until they’ve stopped breastfeeding. Treatment of mild PPD includes recruiting more support to help the mother with care of the infant and psychotherapy to identify stressors and coping skills. In moderate to severe PPD, antidepressants are needed. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are the preferred treatments, and studies support the use of sertraline, fluoxetine, paroxetine, and venlafaxine at their standard dosages. SSRIs and SNRIs are compatible with breastfeeding, because the medications are detected in the breast milk at very low levels. Brexanolone (Zulresso) is the only Food and Drug Administration–approved medication for postpartum depression. It is a neurosteroid and derivative of allopregnanolone, which is a positive allosteric modulator of the gamma-aminobutyric acid receptor. Brexanolone has low oral bioavailability and is administered only as a 60-hour infusion in a certified medical setting with continuous monitoring. The trials for brexanolone included women with moderate to severe PPD, and Hamilton Depression Rating Scale scores (HAM-D) scores ranging from 20 to 25. After the 60-hour infusion, 45% of the subjects with severe PPD in the brexanolone group achieved remission by the end of treatment, compared with 23% in the placebo group. Women retained the antidepressant effect at the 30-day follow-up. The results in the moderate PPD group were not as impressive; these women had a decrease in their depression HAM-D scores, but the antidepressant effect did not continue to the 30-day follow-up. The FDA approval came with a Risk Evaluation Mitigation Strategy in place.   Currently, approximately 100 sites are ready to administer brexanolone; however, some obstacles remain: Obstacles to using brexanolone The medication costs more than $30,000 per infusion, and it is uncertain how much insurance will cover. Since brexanolone is administered in hospital settings, women must be separated from their children for several days. Breastfeeding must be stopped while women are on the medication because of the lack of data about excretion in breast milk. Brexanolone is labeled as a Schedule IV medication because it has a similar mechanism of action to midazolam and diazepam. Likelihood of diversion is low, but some women with substance abuse histories might be concerned about this treatment.  References Leader LD et al. Brexanolone for postpartum depression: Clinical evidence and practical considerations. Pharmacotherapy. 2019 Nov;39(11):1105-12. Meltzer-Brody S et al. Brexanolone injection in postpartum depression: Two multicenter, double-blind, randomized, placebo-controlled, phase 3 trials. Lancet. 2018 Sep 22;392(10152):1058-70. Nonacs R. A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years. New York, NY: Simon & Schuster; 2006. Massachusetts General Hospital Center for Women’s Mental Health. womensmentalhealth.org National Institutes of Health. Drugs and Lactation Database (LactMed). *  *  *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgePsych  

In this deep dive into psychedelics we explore how psychedelics compare to traditional psychotropic (antidepressant) medications. In this fascinating conversation Dr Malcolm compares and contrasts the efficacy and side effect profile of several psychedelics (psilocybin, ayahuasca, mescaline, LSD) to major classes of psychotropics (SSRI and SNRIs). Dr. Malcolm is uniquely qualified to have this in depth conversation into the clinical considerations of psychedelics and antidepressants due to being a board certified psychiatric pharmacist (BCPP) with a special interest in psychedelics. Clinically, he provides specialty services in psychiatric pharmacy at Emanate Health’s Intercommunity Hospital to psychiatric inpatients. His research interests include traditional psychotropics, complementary and alternative therapies, as well as the emerging and experimental psychedelic-assisted psychotherapies. Additionally, he writes academic blogs, speaks, and provides private consultation services for psychedelic drugs via his website: spiritpharmacist.com. Dr. Malcolm earned his bachelor’s degree (BS) in pharmacology at the University of California at Santa Barbara, prior to his Masters in Public Health (MPH) and Doctorate of Pharmacy (PharmD) at Touro University California. He then completed post-graduate residencies in Acute Care at Scripps Mercy Hospital and Psychiatric Pharmacy at the University of California at San Diego Health. He currently serves as Assistant Professor of Pharmacy Practice at Western University of Health Sciences' College of Pharmacy. For more information you can visit: spiritpharmacist.com

Serotonin! Dopamine! Norepinephrine! Neurotransmitters: what's their deal? Dr. Crystal Dilworth, aka Dr. Brain, stops by to have a spirited discussion about how chemical messengers change our moods and behaviors. We chat about depression, anxiety, what chemicals drive us to get off the couch, how antidepressants work, ADHD, addiction, the microbiome, new habits, quitting smoking, starting meditation, Oreos vs. cocaine, SSRIs vs. SNRIs, what it's like to hold a human brain in your hands and if she would donate hers to science. Also: what's up with "lizard brains?" Dr. Dilworth's website: www.crystaldilworth.com Social media links: www.instagram.com/polycrystalhd & www.twitter.com/polycrystalhd A donation went to: seejane.org Sponsor links: withcove.com/ologies; mytruition.com/ologies; LinkedIn.com/ologies; betterhelp.com/ologies (code: OLOGIES); Stitchfix.com/ologies More links up at alieward.com/ologies/molecularneurobiology Transcripts & bleeped episodes at: alieward.com/ologies-extras Become a patron of Ologies for as little as a buck a month: www.Patreon.com/ologies OlogiesMerch.com has hats, shirts, pins, totes and STIIIICKERS! Follow twitter.com/ologies or instagram.com/ologies Follow twitter.com/AlieWard or instagram.com/AlieWard Sound editing by Jarrett Sleeper of MindJam Media & Steven Ray Morris Theme song by Nick Thorburn Support the show.

ACR osteoarthritis guidelines author, Dr. Tuhina Neogi (Boston University; @tuhinaneogi) schools us on all things OA, including new understandings of pathophysiology, diagnosis, when to order imaging and labs, and an overview of pharmacologic and nonpharmacologic therapies. Plus, get answers to your questions from Twitter on CBD, turmeric, glucosamine, chondroitin, NSAIDS, intra-articular steroid and hyaluronic acid injections, tai chi, and more! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Full show notes at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written (including CME questions) and Produced by: Beth Garbitelli and Matthew Watto MD, FACP Cover Art and Infographic by: Beth Garbitelli Hosts: Beth Garbitelli, Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guest: Tuhina Neogi MD, PhD Partners Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud. Tell us why you are I.M. Proud and enter the contest by visiting www.acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019! What makes you proud to practice internal medicine or one of the I.M. subspecialties?  What recent patient experience made you proud to be an internist or subspecialist? How is internal medicine unique from other subspecialties? See us at the CHEST 2019 Annual Meeting in New Orleans! We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!!   Time Stamps 00:00 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 00:15 Cold open, disclaimer, intro and guest bio 05:44 Guest one-liner, Picks of the Week*: Joe Nesbo mystery novels, The Snowman (film), Midsommar (film), Won’t You Be My Neighbor (film), @vermontkitchen Beth’s food blog, Serious Eats; Buy Yourself a Ballistic Jump Rope 07:55 Dr. Neogi’s Women in Medicine moment of awakening 15:40 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 17:35 Case of Osteoarthritis; Initial history and exam 23:23 Imaging for osteoarthritis 28:45 Physical exam for OA 31:45 Osteoarthritis risk factors 33:48 Pathophysiology of OA 37:43 Targeted therapies for OA are in the pipeline; Weight loss and joint protection 41:35 Mechanisms of pain in OA and recognizing pain phenotypes 46:58 Mainstays of osteoarthritis treatment 49:56 Capsaicin, Acetaminophen, and the importance of positivity 52:22 Intra-articular injections with corticosteroids or hyaluronic acid 57:25 Occupational therapy, More on Topical and Oral NSAIDS; SNRIs (duloxetine)   62:00 Questions from Twitter: CBD and marijuana (cannabis), turmeric, fish oil (omega 3 fatty acids) 65:03 More from Twitter: Glucosamine/chondroitin, acupuncture, tai chi, yoga, mindfulness, meditation 70:42 New targets for osteoarthritis; Take Home Points 73:40 Outro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will learn to classify osteoarthritis (OA), assess symptom management, counsel patients on lifestyle modifications, manage pharmacologic interventions for OA, and counsel patients about complementary and alternative therapies commonly suggested by popular culture. Learning objectives After listening to this episode listeners will be able to... Differentiate OA from other joint pathologies like rheumatoid arthritis Diagnose osteoarthritis and select patients who warrant imaging or labs Describe the pathophysiology of osteoarthritis Counsel patients on appropriate lifestyle modifications for management of OA symptoms Choose appropriate pharmacotherapy for osteoarthritis and counsel patients about potential risks and benefits Counsel patients about supplements and complementary, alternative medicine therapies commonly suggested by popular culture Disclosures Dr Neogi has acted as a consultant to Pfizer and Novartis for osteoarthritis therapies still in clinical trials. No trade names were used during the podcast and a balanced range of therapeutic options was included in the discussion. The Curbsiders report no relevant financial disclosures.  Citation Neogi T, Garbitelli B, Williams PN, Watto MF. “#177 Osteoarthritis Master Class with Tuhina Neogi MD, PhD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. October 14, 2019.

Today’s question is: What if You Can’t Use An SSRI in GAD? Here is a summary of this episode: The first-line alternatives to SSRIs in GAD are SNRIs, buspirone, hydroxyzine, pregabalin, and bupropion. Benzodiazepines are not recommended first-line agents for GAD due to their prominent side effect profile. Antipsychotics are not recommended as augmenting agents in GAD due to their high risk of metabolic side effects, negative effects on insulin resistance.   Download a PDF of this interview here Become a premium member of the Psychopharmacology Institute

Dr. Jerrold Rosenbaum is the Chief of Psychiatry at Massachusetts General Hospital, a Professor of Psychiatry at Harvard and is recognized as one of the leading authorities in mood and anxiety disorders. He is the chair of the board of the American Foundation for Suicide Prevention and as a part of mental health awareness month I am honored to have him on the show. We talk about antidepressants vs. placebo, the difference between SSRIs, SNRIs and NDRIs, Ketamine as an option for treatment-resistant depression, the role of exercise, inflammation and the gut microbiome in depression/anxiety and what makes him optimistic about the future of psychiatry. This episode is packed with information and Dr. Rosenbaum does a phenomenal job at clarifying some of the misinformation and contradictory information on the internet regarding psychiatry through his expertise from 45 years of being a leader in the field.

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

I’ve been experiencing chronic pain in my arm very recently which I attributed to overuse from playing tennis. This conversation got me really thinking about what this injury could mean on a deeper level. In this episode my expert guest and I explore: Can negative thoughts such as “unspeakable anger" manifest as pain in our bodies?Why is it that two people can show the same exact damage from an injury on an MRI but feel the pain in two very different ways?What are some steps we can take to help our chronic pain go away? Can working through our past and present anger prevent chronic pain from emerging?My guest for this episode, Dr. Jeff Axelbank, is a psychologist and expert on chronic pain. Dr. Axelbank is a recipient of the New Jersey Psychological Association (NJPA) Psychologist of the Year Award and the Rutgers University Graduate School of Applied and Professional Psychology (GSAPP) Peterson Prize for outstanding contributions to professional psychology. Learn more about his work and practice at www.jeffreyaxelbankpsyd.com. Dr. Axelbank practices the Sarno approach to addressing chronic pain, of which more information can be found at www.tmswiki.org. An additional “fun fact’ about chronic pain that I learned while preparing this podcast but didn’t have a chance to mention was the relationship between norepinephrine and pain. Norepinephrine is a neurotransmitter we produce in the brain that regulates our mood. Certain antidepressant medications work by accessing more norepinephrine. Norepinephrine travels from the brain and through the body and inhibits pain in areas where it’s not useful for us to have pain, such as the stomach, joints and back. When the body is constantly shooting messages of pain to the brain this is a stressor. If, as a result of stress, we produce less norepinephrine to be distributed to the body, we will feel more pain in our back, joints and stomach. This explains why antidepressant drugs like SNRIs that attempt to access more norepinephrine can be helpful for syndromes which cause joint pain and chronic pain, such as in Fibromyalgia. This episode is dedicated to Ginnie’s House, a non profit organization which provides100% free therapy for abused children. Learn more at GinniesHouse.org. If you have found value in listening to this or previous episodes, please leave Psychology America with Dr. Alexandra a rating, it truly makes a difference! How to leave a rating on iTunes1) Launch Apple’s purple Podcast app in your phone2) Even if you already subscribe to / have Psychology America and it is open, tap “Search”3) Enter “Psychology America with Dr. Alexandra” 4) Tap on the photo of the podcast5) Scroll all the way down6) Press the star rating you choose and/or tap the “write a review.” For the highest rating tap the last star on the right first. Your review is appreciated!

Dr Nicholas T. Vozoris from the University of Toronto explains that prescribers should use caution when initiating serotonergic antidepressant in patients with COPD, particularly older patients.

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.

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of generalized anxiety disorder with Dr. Jared Peck, a Staff Psychiatrist at Mount Sinai Hospital in Toronto. In this episode, Jordan Bawks (PGY2 resident) and Bruce Fage (PGY4 resident) reunite with Dr. Peck to talk about the bio-psycho-social management of GAD. They cover recommended lifestyle changes for people with GAD, evidence-based pharmacotherapies, including SSRIs, SNRIs, Pregabalin, Quetiapine, TCAs and benzodiazepines, and how to choose between them, and psychotherapeutic treatments with a focus on CBT and a quick overview of some of the third wave cognitive models. By the end of this episode, the listener will be able to… List the lifestyle changes recommended for people with GAD Describe the first line and second line medication therapies for GAD and the rationale supporting each agent's place in the treatment hierarchy  Appreciate the key elements of CBT that make it effective for the treatment of GAD Relevant Articles: Generoso et al., 2017 (Pregabalin for GAD metaanalysis) Katzman et al., 2014 (Canadian Anxiety Guidelines) Perrin et al., 2019 (Laval model) Please Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association or the University of Toronto and are not meant to replace formal clinical education or judgment. 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.

I wanted NSI-189 to be real so badly. Pharma companies used to love antidepressants. Millions of people are depressed. Millions of people who aren’t depressed think they are. Sell them all a pill per day for their entire lifetime, and you’re looking at a lot of money. So they poured money into antidepressant research, culminating in 80s and 90s with the discovery of selective serotonin reuptake inhibitors (SSRIs) like Prozac. Since then, research has moved into exciting new areas, like “more SSRIs”, “even more SSRIs”, “drugs that claim to be SNRIs but on closer inspection are mostly just SSRIs”, and “drugs that claim to be complicated serotonin modulators but realistically just work as SSRIs”. Some companies still go through the pantomime of inventing new supposedly-not-SSRI drugs, and some psychiatrists still go through the pantomime of pretending to be excited about them, but nobody’s heart is really in it anymore.

Get for ready for some fun psychopharm basics! In this episode, we will discuss commonly used antidepressants including SSRIs, SNRIs, and atypical antidepressants. We’ll review general indications, side effects, and clinical circumstances which might cause you to favor one antidepressant over another. Finally, we’ll help you to solidify your knowledge with some clinical cases.  Photo […]

Today in FirstWord:

Host: Prathima Setty, MD What is the practical approach in treating and counseling patients suffering from hot flashes? Dr. Susan Reed discusses the latest research on herbal supplements, such as black cohosh therapy; as well as, pharmacologic options: SSRIs, SNRIs and Gabapentin. Dr. Susan Reed is the Professor and Division Director of the Women's Health and Adjunct Appointment, Epidemiology, Clinical Services Director at the UW National Center of Excellence in Women's Health at the Univesity of Washington Schoolf of Medicine, Seattle, Washington. About NAMS The interview was conducted live at The North American Menopause Society (NAMS) 2014 meeting. Founded in 1989, NAMS is North America's leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging. Its multidisciplinary membership of 2,000 leaders in the field-including clinical and basic science experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education-makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause and healthy aging. To learn more about NAMS, visit www.menopause.org.

Date: 2010-11-02 Topics: Mind Control Methodologies, Drugs, Pharmaceutical Industry, Western Medicine, Anti-Depressant Drugs, SSRIs, SNRIs, Psychedelics, Enthoegens Related Images: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 Related Videos: Generation Rx | Making A Killing | The Pharmacratic Inquisition