Podcasts about tricyclic

OCD, or Obsessive Compulsive Disorder, is a debilitating condition that involves intrusive thoughts and time-consuming, repetitive behaviors. It impacts 80 million worldwide, 2-4% of the US population or 1 in 100 people here in the US.It can be difficult to overstate the suffering caused by OCD, not only for those with this condition but also for their family members. In addition to the distress caused by the obsessional thoughts and compulsions, there can be shame and loss - loss of more meaningful, purposeful, or pleasant thoughts and behaviors. and loss of time connecting with others or engaging in purposeful or enjoyable activities.Other conditions associated with obsessive-compulsive disorder include:* Body dysmorphic disorder* Skin picking* Trichotillomania (hair pulling)* Hoarding* Hypochondria* Olfactory reference syndrome (an irrational feeling or belief that one emits a foul smell and often attempts to remove the odor).It´s not unusual for someone with OCD to have other conditions, such as:* Other forms of anxiety* Depression* ADHD* Autism spectrum disorder* Eating disorders* TourettesResearch suggests that having OCD raises one´s vulnerability to developing dementia. Many other brain conditions, however, also appear to increase this vulnerability similarly.Treatment ChallengesOCD is particularly challenging to treat. Of those with OCD, 60% do not respond to typical therapies (often medication in combination with psychotherapy involving gradual exposure to that which is being avoided). Typical medications include:* SSRI´s (Selective Serotonin Reuptake Inhibitors) -e.g., sertraline, fluoxetine, fluvoxamine, citalopram, paroxetine* Tricyclic antidepressant - clomipramine* SNRI - (Serotonin and Norepinephrine Reuptake Inhibitor) - venlafaxine* Atypical antipsychotic medications are sometimes addedMedication is combined with CBT (Cognitive Behavioral Therapy), which involves exposure and response prevention, or CBT is used alone.As you can see, most medication approaches aim to increase serotonin activity. Serotonin, however, is just one of the neurotransmitters involved. What has become increasingly clear from the research is that OCD involves abnormal activity at the NMDA receptor - a glutamate receptor.NMDA & GlutamateThe NMDA receptor is found throughout the brain. Glutamate, the primary excitatory neurotransmitter in the central nervous system, binds to the NMDA receptor. NMDA and glutamate are involved in synaptic plasticity (creating neuronal connections), learning, memory, and motor function.The synapse is the space between communicating neurons. Presynaptic neurons release glutamate, which binds to the NMDA receptor on postsynaptic neurons. This results in a cascade of signaling events that lead to “neuronal excitation.” The problem arises when this receptor has too much (or too little) activity. In the case of OCD, there is too much activity.Implications* Dysregulation at the NMDA receptor appears to play a role in OCD, depression, PTSD, schizophrenia, bipolar disorder, and substance use disorders.* Weak memory extinction can result from high activity at the NMDA receptor. While memory is a good thing, we can have problems with too much memory - or rather, problems putting our memories aside. This can look like thoughts getting stuck, for example:* Intrusive thoughts in OCD* Flashbacks in PTSD* Delusions in psychotic disorders* Cravings in addiction.* Neurodegenerative disorders, such as Alzheimer's, Parkinson's, and ALS, have also been linked to NMDA receptor malfunction.Methylation & NMDAThose who are undermethylated, especially those with OCD or addictions, have high activity at the NMDA receptor. To remind you, undermethylation is a biochemical process with many functions, including the breakdown of histamine, support of detoxification, and support of serotonin activity. When someone is undermethylated, they can tend to have allergies (from high histamine), be perfectionistic, competitive, strong-willed, have obsessive-compulsive tendencies, be ritualistic, have dietary inflexibility, and have high accomplishment or have family members with high accomplishment. Undermethylation can contribute to the low serotonin activity seen in OCD. Simply addressing undermethylation, like merely addressing serotonin, will only bring partial benefit. To address undermethylation, those of us trained by the Walsh Research Institute, use SAMe and/or methionine, B12, B6, magnesium, and antioxidants. We address this before starting methylation treatment for those with high homocysteine. But how can we also decrease activity at the NMDA receptor?Blocking NMDA & Normalizing Glutamate ActivityEsketamine or Ketamine, which has been getting much attention in recent years, can impact the brain in various ways; however, its primary mechanism is as an NMDA blocker or antagonist. For some, it can serve as a rapid-acting and highly effective antidepressant. It can also decrease OCD symptoms. Other NMDA-blocking drugs include memantine and dextromethorphan (combined with bupropion). Lamotrigine can decrease glutamate release and has been used as an adjunct medication for OCD.Nutrients, however, play an important role in the NMDA receptor. NAC or N-acetyl cysteine is a precursor to glutathione and, thus, an antioxidant. It is also anti-inflammatory and a binder for a particular toxin made by candida and mold. But, it is also a potent NMDA antagonist (decreases activity at NMDA) and has been shown to reduce obsessions and compulsions of OCD. It has also been studied in alcoholism, opiate addiction, cocaine abuse, gambling disorder, shopping disorder, cigarette addiction, and trichotillomania. It has been used by itself and as an adjunct to medication therapy. NAC has become part of the Walsh undermethylation nutrient protocols for those with OCD and/or addiction.Zinc also plays an important role in regulating functioning at the NMDA receptor. The Walsh Research Institute found that 90% of those with brain symptoms had relatively low zinc. Dosing of zinc is determined after testing plasma zinc levels using a narrow range (the Walsh/Pheiffer range differs from typical lab ranges). Zinc is checked in conjunction with copper. Zinc has been found to improve treatment response in those with OCD treated with SSRIs. Zinc can be depleted because of very high oxidative stress and/or high pyrroles, which also cause low B6. Because B6 is needed to make serotonin, pyrroles are also important to address if elevated.Inositol is a nutrient involved in the serotonin and glutamate signaling systems. It, too, is beneficial for OCD symptoms; however, it can require very high doses.The challenge of research, as you can see, is that these approaches are all looked at in isolation, as opposed to, for example, addressing undermethylation, optimizing zinc, decreasing activity at the NMDA and addressing sources of oxidative stress.Candida & MoldAside from undermethylation, low serotonin activity, and high activity at the NMDA receptor, those with OCD appear to have high oxidative stress, as is the case with most brain-related conditions. One of the more common sources of oxidative stress I see in my practice is candida overgrowth in the GI tract, which often follows antibiotic exposure and /or mold toxicity due to water damage causing seen or unseen toxic mold. Because mold and candida (yeast) thrive on sugar and a high-carb diet, symptoms can fluctuate with sugar or carb intake. How might candida and mold intersect with the NMDA receptor? Mold and yeast can contribute to high histamine states. Histamine can increase activity at the NMDA receptor. EstrogenFor women and teen girls that I see with OCD, there is often a fluctuation in their OCD symptoms with their cycle. Typically, their symptoms worsen during the times of the month when estrogen is the highest. This may be because estrogen can increase activity at the NMDA receptor.PANDAS & PANSWhen a child has an abrupt onset of OCD symptoms, PANDAS and PANS should be considered.* PANDAS = Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections* PANS = Pediatric Acute-Onset Neuropsychiatric SyndromePANDAS and PANS are autoimmune conditions, meaning the immune system is acting on the body, in this case, a part of the brain called the basal ganglia, that involves an acute onset of OCD symptoms. Other symptoms can include restricted eating, mood symptoms, regression in academic or social skills, and motor tics. While triggers are often viral, bacterial (strep in the case of PANDAS), candida,or other microbial source, what is underlying the dysregulated immune response to such microbes, in my experience, is mold toxicity. SummaryBecause OCD can be difficult to treat, my hope in sharing this information is to raise awareness that effective OCD treatments can require a multifaceted approach that includes:* addressing methylation (and high pyrroles if present) to improve serotonin activity* decreasing activity at the NMDA receptor* by optimizing zinc* using supplements or medication* addressing sources of inflammation and high histamine* address sources of oxidative stress - trauma, stress, toxins, inflammation If you find this information helpful and would like to help me get this out into the world, please consider sharing:As always, I welcome your comments, questions, and experience.Until next time,CourtneyP.S. To learn more about non-patient consultations, treatment, and monthly mentorship groups, please visit my website at:CourtneySnyderMD.comMedical Disclaimer:This newsletter and podcast episode is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment for yourself or others, including but not limited to patients you are treating (if you are a practitioner). Consult your physician for any medical issues that you may be having. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit courtneysnydermd.substack.com/subscribe

In this episode, we review the high-yield topic Tricyclic Antidepressants (TCAs)⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠from the Psychiatry section at ⁠⁠⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠ 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

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

Contributor: Taylor Lynch MD Educational Pearls: Anticholinergics are found in many medications, including over-the-counter remedies Medications include: Diphenhydramine Tricyclic antidepressants like amitriptyline Atropine Antipsychotics like olanzapine Antispasmodics - dicyclomine Jimsonweed Muscaria mushrooms Mechanism of action involves competitive antagonism of the muscarinic receptor Symptomatic presentation is easily remembered via the mnemonic: Dry as a bone - anhidrosis due to cholinergic antagonism at sweat glands Red as a beet - cutaneous vasodilation leads to skin flushing Hot as a hare - anhidrotic hyperthermia Blind as a bat - pupillary dilation and ineffective accommodation Mad as a hatter - anxiety, agitation, dysarthria, hallucinations, and others Clinical management ABCs Benzodiazepines for supportive care, agitation, and seizures Sodium bicarbonate for TCA toxicity due to widened QRS Activated charcoal if patient present < 1 hour after ingestion Temperature monitoring Contact poison control with questions Physostigmine controversy Acetylcholinesterase inhibitor Black box warning for asystole and seizure Contraindicated in TCA overdoses Crosses blood-brain barrier, so useful for TCA overdoses Indicated only in certain anticholinergic overdose with delirium Disposition Admission criteria include: symptoms >6 hours, CNS findings, QRS prolongation, hyperthermia, and rhabdomyolysis ICU admission criteria include: delirium, dysrhythmias, seizures, coma, or requirement for physostigmine drip References 1. Arens AM, Shah K, Al-Abri S, Olson KR, Kearney T. Safety and effectiveness of physostigmine: a 10-year retrospective review. Clin Toxicol (Phila). 2018;56(2):101-107. doi:10.1080/15563650.2017.1342828 2. Nguyen TT, Armengol C, Wilhoite G, Cumpston KL, Wills BK. Adverse events from physostigmine: An observational study. Am J Emerg Med. 2018;36(1):141-142. doi:10.1016/j.ajem.2017.07.006 3. Scharman E, Erdman A, Wax P, et al. Diphenhydramine and dimenhydrinate poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2006;44(3):205-223. doi:10.1080/15563650600585920 4. Shervette RE 3rd, Schydlower M, Lampe RM, Fearnow RG. Jimson "loco" weed abuse in adolescents. Pediatrics. 1979;63(4):520-523. 5. Woolf AD, Erdman AR, Nelson LS, et al. Tricyclic antidepressant poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2007;45(3):203-233. doi:10.1080/15563650701226192 Summarized by Jorge Chalit, OMSIII | Edited by Jorge Chalit  

This is the 4th podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of tricyclic antidepressant therapies. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Michael Lang, MD, FACP, DFAPA & Monica Sharma, MD

This is the 3rd podcast episode for the Psychiatric Medication Podcast Series. Series Description: Current literature indicates that podcasts can be an effective educational format to reach health professionals across the continuum of medical education, addressing a myriad of topics pertinent to providers. This episode serves as an overview of tricyclic antidepressant therapies. This podcast season is the second released by East Carolina University's Office of Continuing Medical Education and may be beneficial for physicians, residents, fellows, nurse practitioners, physician assistants, and nurses. This podcast season is comprised of approximately 30 episodes, each focusing on different psychiatric medications for the non-psychiatric provider. Those tuning into the podcast's second season will receive a primer on the "bread and butter" behavioral health medications for primary care: antidepressants, antipsychotics, and mood stabilizers. Episodes will be released weekly on Wednesdays.Michael Lang, MD, FACP, DFAPA & Monica Sharma, MD

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

Welcome all to IS PHARMACOLOGY DIFFICULT Podcast! I am Dr Radhika Vijay.In today's episode, I will be conversing about Uses of Anticholinesterases in general.Actually it gonna be a list, and main uses talked about are - Lambert Eaton Syndrome, Cobra bite, Belladona poisoning, Alzheimer's disease, post operative Paralytic ileus and post operative decurarization and treatment of excessive dosing of certain group of drugs (Antihistamines and Tricyclic antidepressants)It happened to be a nice preaching program after a little break, but in my opinion and realisation, I like to converse in continuation, what's your point of view, do let know........For all the updates and latest episodes of my podcast, please visit-  www.ispharmacologydifficult.com  where you can also sign up for a free monthly newsletter of mine. It actually contains lot of updates about the medical sciences, drug information and my podcast updates also.You can follow me on different social media handles like twitter, insta, facebook and linkedin. They all are with same name "IS PHARMACOLOGY DIFFICULT". If you are listening for the first time, do follow me here, whatever platform you are consuming this episode, stay tuned, do rate and review on ITunes, Apple podcasts.Stay safe, stay happy, stay enlightened, Thank you!!You can access various links via- https://linktr.ee/ispharmacologydifficult

Welcome all to IS PHARMACOLOGY DIFFICULT Podcast! I am Dr Radhika Vijay. In today's episode, I will be conversing about Uses of Anticholinesterases in general. Actually it gonna be a list, and main uses talked about are - Lambert Eaton Syndrome, Cobra bite, Belladona poisoning, Alzheimer's disease, post operative Paralytic ileus and post operative decurarization and treatment of excessive dosing of certain group of drugs (Antihistamines and Tricyclic antidepressants) It happened to be a nice preaching program after a little break, but in my opinion and realisation, I like to converse in continuation, what's your point of view, do let know........ For all the updates and latest episodes of my podcast, please visit- www.ispharmacologydifficult.com where you can also sign up for a free monthly newsletter of mine. It actually contains lot of updates about the medical sciences, drug information and my podcast updates also. You can follow me on different social media handles like twitter, insta, facebook and linkedin. They all are with same name "IS PHARMACOLOGY DIFFICULT". I f you are listening for the first time, do follow me here, whatever platform you are consuming this episode, stay tuned, do rate and review on ITunes, Apple podcasts. Stay safe, stay happy, stay enlightened, Thank you!! You can access various links via- https://linktr.ee/ispharmacologydifficult

In this episode, we review the high-yield topic of Tricyclic Antidepressants (TCAs) from the Psychiatry section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

In this episode, we review the high-yield topic of Tricyclic Antidepressants (TCAs) 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

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

This episode covers tricyclic antidepressants!

In today's episode of the podcast, we'll be doing a deep-dive into nortriptyline, a lesser-talked about medication in psychopharmacology. We'll cover a little about the history of tricyclic antidepressants (TCAs) as well as the characteristics, side-effects, and indications to consider when prescribing this class of medication. Link to Blog. Link to Resource Library.

Thank you Brandon Trujillo, OMS IV for continuing a thoughtful series on treatment of depression and key principles of algorithmic treatment and key aspects of antidepressant use. This is a modest yield podcast as there will be questions regarding principles in this podcast that are likely to show up in tests. Thank you Jason Hemingway, OMS IV and Natalie Pratt, OMS IV for participating in the discussion.

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

On this episode, I discuss cyclobenzaprine pharmacology. Cyclobenzaprine is an older skeletal muscle relaxant. Cyclobenzaprine can have a significant number of anticholinergic side effects. The anticholinergic side effects of cyclobenzaprine can include sedation, dry eyes, dry mouth, urinary retention, and confusion. Cyclobenzaprine is not well tolerated in the elderly and cause more problems in that patient population. Cyclobenzaprine has a similar structure to the Tricyclic antidepressants.

The TCA's are one of the older antidepressant type medications that can be used for a whole host of reasons.  They are not without potential concerns however.  I cover the MOA, drug interactions, side effects and clinical practice pearls of the tricyclic antidepressants in this episode.

In this episode Dr Nirala Jacobi continues the conversation with Dr Bradley Bush, with a focus on case presentations around chronic SIBO cases and inflammatory concepts.   Dr Bush received his Naturopathic Doctorate degree from the National College of Naturopathic Medicine.  He is co-owner and clinic director of Natural Medicine of Stillwater and its online consumer direct website for practitioners, neurovanna.com.   The Bush practice focuses on fatigue, insomnia, GI disorders, mood disorders, and lyme disease. Dr Bush has over 16 years of industry experience. He is the owner of Natural Health Insights, providing consulting services to the naturopathic products and laboratory testing industry.   Dr Bush speaks nationally and regularly publishes on the topics of neuroimmunology, brain-gut connections, neuroendocrinology, and lyme disease.  Dr Bush sits on two non profit boards, The Naturopathic Education and Research Consortium, and Compass Centre for Health.   The format of this episode is slightly different. In it Dr Bush discusses three different SIBO cases, diving into the variability and complexity of each presentation.   Case 1 - SIBO with associated fibromyalgia and chronic fatigue - 65y/o female. Incremental approaches with complex cases. The gut being the epicentre of health, without which SIBO associated presentations will not rectify. Polypharmacy approach and the compounding effect of this on the patient. Analysis of basic chemistry. Myeloperoxidase (MPO), the enzyme secreted by neutrophils, and the indications for testing and tracking this in treatments. (MPO elevation has associations with lipopolysaccharides (LPS), chronic infections, irritable bowel disease (IBD), and immune induced leaky gut) The neurotransmitter imbalances that can be sustained by chronic inflammation (hint - upregulated indoleamine dioxygenase enzyme, precipitating downregulated synthesis of serotonin, among others) Yeast association with SIBO. Weaning off polypharmacy. Metronidazol for rifaximin resistant SIBO, and C. diff. An indication on how many rounds of rifaximin are required to attend to chronic versus acute SIBO. Eating disorders prompted by therapeutic diets taken on for too long. Botanicals vs conventional medicine for SIBO treatment, or a combination use approach? Probiotic use as immunological modulators rather than massive impactors for floral diversity in the GI microbiome. Botanicals that Dr Bush uses in SIBO treatment. Mediherb gut flora complex - immune regulating capability, IBD modulation, mucosal affinity. Dr Nirala Jacobi's therapeutic recommendation - Mediherb Bacto-Cand GI.   Case 2 - SIBO with associated constipation, acne, halitosis - 20y/o male Traumatic brain injury due to sporting event. Tricyclic antidepressant therapy introduced in his recovery plan and his subsequent experience of anxiety and spacey feelings. Naturopathic neurotransmitter production therapy alongside conventional antidepressant use. Serotonin syndrome and the potential for it to be induced by dual therapy use. Methane Protocol - rifaximin and neomycin combination for methane dominant SIBO treatment. Anxiety caused by SIBO, key indications being: Treatment resistant anxiety Treatment resistant insomnia Anxiety as a manifestation resultant of SIBO chemicals interrupting neurotransmitter signalling.   Case 3 - Lyme and SIBO - 25y/o female Chronic fatigue, constipation, bloating, neuralgia, catatonic staring episodes. Lyme testing. The effectiveness of the paleo diet for symptomatic control, noting that the issue still exists, even though the bugs are simply not being fed and therefore symptoms abating. SIBO as a concomitant condition with Lyme, and/or as a condition that can mimic the various presentations of Lyme. The Lyme/SIBO overlap as discussed by Dr Farshid Rahbar at the 2017 SIBO Integrative Conference, and the methane association. The clinically noted neuralgia and methane dominance link. Methane endotoxins produced by SIBO bacteria theorised to contribute to neuralgia. Constipation and methane dominance perpetuating each other. Methane dominant SIBO moving from constipation to diarrhoea during treatment and why this can occur.   Resources Dr Bradley Bush Clinic website - Still Water Natural Clinic Direct consume website for practitioners - Neurovanna Therapeutic recommendation, Mediherb gut flora complex Dr Nirala Jacobi's therapeutic recommendation Mediherb Bacto-Cand Naturopathic Education and Research Consortium Compass Centre for Health Dr Farshid Rahbar SIBOtest episode - SIBO and Lyme Disease SIBO Integrative Conference

TCA overdose an uncommon presentation to the Emergency Department. TCA overdoses can however be fatal.

David Rosenblum, MD interviews EP Cardiologist Ron Shnitzer, MD Topics discussed in this podcast include: QT Prolongation Tricyclic Medication Side Effects Cardiac Clearance vs. Optimization Interventional Procedures in the Anticoagulated Patient   PainExam Podcast Download our iphone App! Download our Android App! For more information on Pain Management Topics and keywords Go to PainExam.com David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com 718 436 7246 DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.  You should regularly consult a physician in matters relating to yours or another's health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.    Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.        

This week we review Right Axis Deviation from Dr. Amal Mattu's ECG Video of the Week - Why You Should Care When Things are Totally RAD as well as EMCrit Episode 98 on TCA Overdose treatment Then, we delve into core content toxicology pearls regarding tricyclic antidepressants and sodium channel blockade using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide) in addition to Goldfrank's Toxicology Key Texts: Tintinalli (7e): Ch 171; Rosen's (8e) Ch 151 Goldfrank Ch 73  As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Tricyclic overdoses are not uncommon and these patients can be incredibly ill.

A doctor at the Royal Free Hospital's Pain Clinic performs a procedure and explains how medication can help alleviate pain.

Transcript -- Doctors and patients at the Royal Free Hospital's Pain Clinic and at the Real Health Institute explain how chronic pain works

Doctors and patients at the Royal Free Hospital's Pain Clinic and at the Real Health Institute explain how chronic pain works

Transcript -- A doctor at the Royal Free Hospital's Pain Clinic performs a procedure and explains how medication can help alleviate pain.

Transcript -- A doctor at the Royal Free Hospital's Pain Clinic performs a procedure and explains how medication can help alleviate pain.

A doctor at the Royal Free Hospital's Pain Clinic performs a procedure and explains how medication can help alleviate pain.

Transcript -- Doctors and patients at the Royal Free Hospital's Pain Clinic and at the Real Health Institute explain how chronic pain works

Doctors and patients at the Royal Free Hospital's Pain Clinic and at the Real Health Institute explain how chronic pain works