Podcasts about venlafaxine

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

These are some Venlafaxine stories that will make you quiver...

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

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

In this episode, I discuss venlafaxine pharmacology, adverse effect, dose conversion of IR to ER, and drug interactions. Venlafaxine is notorious for producing withdrawal symptoms when discontinued abruptly. I discuss these in detail on the podcast. How significant is the interaction of venlafaxine with antiplatelet agents? I discuss that in this episode. The onset of action is a critical education point that patients must be aware of as it takes some time for venlafaxine to work.

I'm sharing my journey with medication. 

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

Perhaps the most mysterious death of the 21st century is that of Elisa Lam. We share the tragic story of this young woman on this edition of Unpleasant Dreams. Cassandra Harold is your host. EM Hilker is our principal writer and researcher with additional writing by Cassandra Harold. Jim Harold is our Executive Producer. Unpleasant Dreams is a production of Jim Harold Media. SOURCES AND FURTHER READING: Anderson, Jake. Gone at Midnight: The Mysterious Death of Elisa Lam. Citadel, 2020.  Anon. “Questions Remain Three Years After…” LosAngeles.cbslocal.com. https://losangeles.cbslocal.com/2016/10/31/questions-remain-3-years-after-womans-body-was-found-inside-la-hotels-rooftop-water-tank/ Retrieved 16 February 2021.  Barrett, Christina. The Mysterious Death of Elisa Lam. CreateSpace, 2016. Brown, Jack. “Body Language Analysis No. 2313: Elisa Lam Video in Elevator at Cecil Hotel.” BodyLanguageSuccess.com. https://www.bodylanguagesuccess.com/2013/02/nonverbal-communication-analysis-2313.html Retrieved 16 February 2021.  Buzzfeed Unsolved. “The Bizarre Death of Elisa Lam.” Youtube. 18 March 2016. https://www.youtube.com/watch?v=48jBi86ih5Q Moncrieff, JH. “Whatever Happened to Elisa Lam?” JHMoncrieff.com. https://www.jhmoncrieff.com/whatever-happened-elisa-lam/ Retrieved 16 February 2021.  Peters, Lucia. Dangerous Games to Play in the Dark. Chronicle Books, 2019. Steel, Danielle. How Elisa Lam Got Disappeared. Sifox, 2017. Swann, Jennifer. “Elisa Lam Drowned in a Water Tank Three Years Ago, but the Obsession with her Death Lives On.” Vice.com. https://www.vice.com/en/article/3bkmg3/elisa-lam-drowned-in-a-water-tank-two-years-ago-but-the-obsession-with-her-death-lives-on-511. Retrieved 16 February 2021.  You can find EM Hilker's full article that this podcast was based upon HERE and a transcript of the podcast version below: PODCAST TRANSCRIPT It was early February of 2013 when some of the residents of the Stay on Main (formerly the Cecil Hotel) began to have problems with their tap water. The water pressure was inconsistent, and the water itself tasted peculiar and was oddly discoloured. In response to the residents' complaints, the hotel sent employee Santiago Lopez to investigate the issue. His investigation took him to the water towers on the roof of the hotel where, upon examination, he found the decomposing body of a solitary young woman, naked, floating in the cistern, her clothing and some personal effects in the water alongside her.  No one recognized by authorities knows precisely how Elisa Lam died. The known facts are that Elisa arrived in Los Angeles on January 26th 2013 and checked into the Stay on Main on January 28th. She was reported missing on February 1st, 2013, after she had fallen out of contact with her family; some time prior to that she displayed seemingly erratic behavior in the hotel elevator, which was caught on tape and has been much-analyzed by professionals and amateur sleuths alike. Her body and clothing were found in one of the rooftop water cisterns, which, in theory, should have been inaccessible by the hotel guests. For a period of time, the guests consumed the water that contained her body, which had been discoloured and had an unwholesome taste. Her clothes were in the cistern as well, covered with what appeared to be sand. It was noted that her cell phone and glasses were missing. Autopsy revealed that she had been dead for several days at a minimum, that there was water in neither her lungs nor her stomach, and that aside from a small abrasion on her knee that she could have gotten anywhere, she had no obvious external trauma that wasn't accounted for by decomposition.  Among the things that are unknown: how did Elisa get in that cistern, which was said to have been difficult to access? How did she get onto the roof, for that matter, where the cisterns are located, past the secured door? What was Elisa up to in that elevator? Was she alone? Before we delve into the details of this strange case, and the plentiful theories of what precisely happened, there is Elisa herself.  She was a young woman, only 21 years old at the time of her death, and at the beginning of her adult life. She had struggled with mental illness for many years, but despite her struggles she was kind, empathetic, dedicated, and passionate. She liked fashion, art, and literature, and found a great deal of solace on her blogs “Nouvelle/Nouveau” and “Ether Fields.” She was close to her parents, with whom she connected each day as she traveled. She called her trip “the West Coast Tour.” She had been very excited about it.   I think it's important to remember who Elisa was. That she was a real, warm, living person with hopes and goals and dreams and struggles. It's easy to forget Elisa herself in the twisting paths of this case, in all the weirdness of the circumstances and the copious amount of theories on what really happened to her. Elisa wasn't just a part of a mystery to be solved: she was a vibrant young woman, taken too soon from a life that she had only just begun. LAM-ELISA TB Test The circumstances surrounding Elisa's death, and her stay in Los Angeles in general, were strange, but little was as strange on the surface as the colossal coincidence of the LAM-ELISA tuberculosis test. The name LAM-ELISA seems like an improbable coincidence. The test was developed at the University of British Columbia, oddly enough, the university Elisa had attended more than four years before her last, fateful trip. LAM-ELISA is named for enzyme-linked immunosorbent assay, or ELISA, an enzyme used to detect lipoarabinomannan (Lie-poe-a-rab-in-o-min-in) (LAM) in samples of human sputum, in order to diagnose tuberculosis in the patient. There was, additionally, an outbreak of TB in the Skid Row section of Los Angeles at the time of Elisa's disappearance. Some conspiracy theories have cropped up around these coincidences, though none really fit the facts. The naming convention of the test is clear and logical, the test itself predates Elisa's stay in LA by literal years, and there was no sign of TB in Elisa's autopsy findings.  Dark Water Another strange coincidence comes in the form of two movies called ‘Dark Water' (a Japanese movie from 2002, and the American remake from 2005) as well as the short story by Koji Suzuki on which the two movies were based. As in Elisa's case, there were water supply issues caused by the body of a young girl in the building's water tower. Interestingly as well, the American remake names the lead character, Dahlia, which just so happens to be the press' nickname for murder victim Elizabeth Short.  The Elizabeth Short who was allegedly drinking at the then-Cecil hotel's bar shortly before her murder.  “The Suicide” The Stay on Main, formerly the Cecil Hotel but re-named in 2011, has a dark and violent history. There have been at least sixteen deaths (that we know of) at the Cecil hotel since the first recorded suicide in November 1931 (a selection of which include: self-poisoning, infanticide, and strangulation). Jake Anderson, author of, Gone At Midnight, the book on the case, believes the number to be higher.  Because of its reputation as a place frequented by death, it was popularly called “The Suicide.” In addition to the selection of murders and suicides in the hotel itself, it was also known for having housed both Richard “The Night Stalker” Ramirez during the period of his murder spree in the 1980s and Austrian serial killer Johann “Jack” Unterweger in the 1990s. Also, as previously mentioned, there is the fact that Elizabeth Short, “The Black Dahlia”, may or may not have had a drink at the Cecil in the last few days of her life. Inaccessible roof and sealed water tower? The roof should have been, many have said, inaccessible. The set of stairs leading to the roof from the fourteenth floor had a security alarm, which was not triggered the night of Elisa's disappearance. Indeed, Santiago Lopez had to disarm it before finding Elisa's body on the roof. There were, however, fire escapes that could be climbed to access the roof. Jake Anderson points out that there was graffiti on the roof, as well as reports of drinking up there; someone was accessing it. The cisterns have been said to be sealed in some sources, but elsewhere simply awkward and heavy. Somebody — Elisa or otherwise — got it open, after all. And then, perhaps most disturbing The Elevator Footage The footage of Elisa playing in an elevator on what was most likely the last day of her life, which the LAPD released to the public on February 15, has gotten a lot of attention online. The footage, as released, is certainly disquieting to watch, if only because of what would happen to her later that night. This footage has originated a number of the theories that we will discuss later. All is not as it seems on the surface, however. Often noted is that the elevator doors take an unusually long time to close in the video, though upon examination Kay Theng found that the doors to the elevator only close upon pressing the “close door” button or upon someone summoning the elevator from another floor. This may have been unusual behavior for elevators in general, but it was not unusual behavior for this particular elevator. Body language expert Dr. Jack Brown believes her body language to be playful rather than afraid, and speculates that there may be another person outside the elevator she's playing with.  However strange the circumstances surrounding her trip may be, the question remains, how did Elisa wind up in that water tower? The Paranormal Theory Well before Elisa's death, the hotel was thought to be haunted. The Ghost Adventures team has recorded a two-hour special in the former Cecil, noting that “it's undeniable that there are spirits inside this building.” Renowned psychic Joni Mayhan was asked to analyze the case for Anderson, and concluded that Elisa had been murdered, her murderer having been influenced by a malevolent force.  The Elevator Game The elevator game, which is said to have originated in Korea, has a very simple premise: you enter an elevator in a building that has a minimum of ten stories, alone, and after entering the elevator on the ground floor,  press the buttons in sequence, each after traveling to the last buttons' floor, without exiting the elevator. The order is 4, 2, 6, 2, 10, 5, 1. Certain things are said to happen along the way – a woman may enter the elevator at the fifth floor, to whom you must neither speak nor look at. It's not clear what happens to you if you do. In theory, if you've done all this correctly, when you press “one” to return to the ground floor, the elevator should instead ascend to the tenth floor, where you will find another world. You can either leave the elevator and explore this new world, an empty, dark world with a burning crucifix in the distance, or reverse the sequence of floors that you pressed to get here. The dark world is said to be hard to find your way back from (you need to use the same elevator that you used to get there). And, internet speculation has it, that Elisa Lam was playing that game in the elevator footage. I have a few problems with this theory: first, and perhaps most importantly: “Elisa had given virtually no attention to the paranormal. In all of her hundreds of pages of writings, not once did she ever reference ghosts, or hauntings, or possessions, or anything in the esoteric paranormal realm,” as Jake Anderson observes. There's no reason to believe that she would have played a relatively obscure game to go to another dimension, when she doesn't seem to have done so much as watched an episode of Ghost Hunters. Secondly, the infamous elevator footage took place on the fourteenth floor. The fourteenth floor isn't part of the elevator game, and the rules are very clear that you must begin on the ground floor. Thirdly, she's shown pressing what appears to be random buttons hurriedly, rather than traveling to each floor before pressing the next button in the sequence, and she doesn't appear to be pressing them in the order of the game. Finally, she leaves the elevator, which you're not to do until you reach the tenth floor. The Mental Health Aspect Elisa Lam was diagnosed and medicated for bipolar disorder, which she seems to have struggled with for most of her life and wrote about at length online. She had been taking medications to treat the disorder, but the toxicology results from her autopsy suggest that she hadn't been taking all of her medications at the time of her death. She appears to have been taking one of her antidepressants (Venlafaxine, ven·luh·fak·seen) regularly, but her other antidepressant (bupropion,byoo·prow·pee·aan) was in small enough amounts to indicate that it had been taken recently but certainly not that day. This was true of her mood stabilizing drug Lamotrigine (luh·mow·truh·jeen) as well. The antipsychotic she had been prescribed, quetiapine (kwuh·tai·uh·peen), was entirely absent from her system.  The autopsy report isn't the only reason to believe that something was amiss, however; Elisa had originally checked into her hotel room with two other women. Several days into Elisa's stay, the roommates complained to management that Elisa was acting in ways that made them uncomfortable, and Elisa was moved to her own room. Anderson had discovered one of the last people to see her alive, a man named Tosh Berman, who had encountered her in a bookstore. He described her behavior as erratic and unbalanced, and noted that he had been worried for her safety, not because of any immediate threat but simply because she was so unstable, and seemed so vulnerable. Skinny Dipping One theory on how Elisa wound up in that water tower is that she got in voluntarily. That perhaps in her manic state, she chose to go skinny dipping, alone, in a water reservoir on the roof of a 19 storey hotel that is — in theory, at least — hard to access, sometime in  February. The average daytime temperature in Los Angeles in February is 21 degrees celsius, or 69.8 degrees fahrenheit. That is, of course, assuming she had stolen away to do this during the day, when it's warmest but also presumably the easiest time to get caught). The interior of the water reservoir was completely smooth, lacking entirely in any way for her to climb back out. The theory is that she realized this too late, and the poor woman was left to tread water, hopelessly, knowing that no one knew she was there, knowing that rescue would never come, until she died.  The Murder/Manslaughter Hypothesis A very common theory is that Elisa was murdered, and that perhaps she was dead before her body entered the cistern. Dr. John Hiserolt believes that she may have been suffocated, and her body thrown in the water tower. He acknowledges the possibility of laryngospasm , sometimes called “dry drowning,” but finds it unusual that there was also no water in her stomach. Many have pointed out that a hotel employee could have accompanied her to the roof without setting off the alarm, and many others have pointed out that there were several registered sex offenders in the hotel at the time of Elisa's death. Jake Anderson himself suspects perhaps a date rape that became a murder. Mystery author JH Moncrieff agrees, writing at one point that “Personally, I think she was murdered, and not by a ghost, either.”  Ultimately, we may never know what happened to Elisa. But there's one more theory I'd like to share with you, which may be no more true than the others, but which accounts for at least most of the facts: It's possible that Elisa may have indeed gone skinny dipping in the water tower, perhaps in a manic state, with whoever she was playing with in the elevator footage. This person may also have helped her open the lid to the cistern. She took off her clothes, her watch, and her hotel key card, placing them in a pile on the floor of the roof, picking up the particulate matter that was found on them, and jumped in the water first. Quickly realizing that there was no way to get back out, her companion perhaps panicked (if this hadn't been the plan all along), and rather than getting help, threw her clothing and personal effects in after her, and left her to die. It's hard to hope for an answer to the mystery of Elisa Lam's death. At the time of this recording, it has been eight years. There is hope, however: recently, Netflix has released a documentary, and Jake Anderson has drummed up new interest with Gone At Midnight. With luck, this new spotlight on the case will lead to fresh information on Elisa, her last days, and perhaps finally an answer to the circumstances surrounding her tragic loss.    

This week we talk with Professor Jim van Os and Doctor Peter Groot about their latest study which looks at the effectiveness of tapering strips to help people get off antidepressant drugs. Jim van Os is Professor of Psychiatric Epidemiology and Public Mental Health at Utrecht University Medical Centre, the Netherlands and Peter Groot works with the User Research Centre of UMC Utrecht. They both are involved with the development and study of tapering strips which are pre-packaged, gradually reducing dosage tablets that facilitate tapered withdrawal from psychiatric drugs. In this interview, we discuss their latest research paper which examines tapering strips in real-world use. *** Download Mad in America's new mobile app here. Available for Apple or Android mobile devices, keep up to date as we publish new audio interviews or browse our archive.  

This week on the MIA podcast, we discuss a recent paper that considers the support provided by online support groups when people seek help for psychiatric drug withdrawal. The paper is entitled ‘The role of Facebook groups in the management and raising of awareness of antidepressant withdrawal: is social media filling the void left by health services?’ It was published in the journal Therapeutic Advances in Psychopharmacology in January 2021 and the authors are Sherry Julo, Ed White and John Read. "In June 2020, the groups had a total membership of 67,125, of which, 60,261 were in private groups. The increase in membership for the 13 groups over the study period was 28.4%. One group was examined in greater detail. Group membership was 82.5% female, as were 80% of the Administrators and Moderators, all of whom are lay volunteers. Membership was international but dominated (51.2%) by the United States (US). The most common reason for seeking out this group was failed clinician-led tapers." Links and further information The role of Facebook groups in the management and raising of awareness of antidepressant withdrawal: is social media filling the void left by health services? Facebook Groups Provide Psychiatric Drug Withdrawal Help When Doctors Don’t Out of the Abyss (with a Little Help from My Friends) Antidepressant Withdrawal: Avoid Doctors? Tens of Thousands Relying on Social Media Support Groups to Withdraw From Antidepressants (video)

Dit is de Let's talk medicine podcast by MedicinXP, gehost door Seyfullah Semen, waarin discussies en onderwerpen over onder andere de zorgindustrie en medicijn gebruik aan bod komen. In deze podcast komen medicijngebruikers, doctoren en mensen uit de zorg aan het woord. Ewout Kattouw was ongeveer 25 jaar geleden naar de dokter gegaan omdat hij faseproblemen had. Na zijn bezoek bij de dokter, kwam Ewout Kattouw naar buiten met wat antidepressiva. In die tijd waren de medicijnen nog redelijk nieuw op de markt. Ewout Kattouw kreeg Venlafaxine toegeschreven. Natuurlijk wist hij niet wat dit was en was ook best wel verbaasd dat hij dit kreeg. Ewout Kattouw dacht namelijk dat hij alleen een gesprek zou hebben om zo de oplossing tot zijn problemen te krijgen. Nadat hij begonnen was met de medicatie kreeg hij een aantal bijwerkingen. Aan het begin wist hij niet dat het door de medicatie kwam. Ook zijn arts was hier niet van op de hoogte. Hij kreeg daardoor meer medicatie en het werd alleen maar erger. Tot zijn verbazing kwam het wel door de Venlafaxine en is hij hier inmiddels over gaan schrijven. Hij wilt een boek publiceren over zijn verhaal met Antidepressiva en de bijwerkingen die hij kreeg door de Antidepressiva. Heeft u zelf een bijwerking en wilt u deze melden? Ga dan naar: https://medicinxp.nl

This episode digs into what life is like on my anxiety medication versus what life is now like post-medication >6 months. My cocktail consisted of Venlafaxine and Adderall XR. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/anxietyandme2/message Support this podcast: https://anchor.fm/anxietyandme2/support

Porpoise Crispy Podcast Volume #8 Episode #11 Venlafaxine (Effexor) Curated by Ryan Obermeyer August 15, 2019        Past Lives…                  This Must Be The Place (Naive Melody)  BrothertigerSylvia Says Charlotte Gainsbourg  Rest       Toast vs Clem Fandango Whispers Part I  Koda.  Best Of Koda The Places We've Been (w Innocence Mission)  Lost Horizons  Ojala Baglaens  Lowly  Hifalutin The One  Marika Hackman Any Human Friend Introducing Palace Players  Mew No More Stories Are Told Today, I'm Sorry, They Washed Away Tiny Crustacean  Nyles LannonTwist (Edit)  Thom Yorke  Anima Scarecrow Wand Laughing Matter                 This life revisited… ThepCrispy is only an hour of music so I know you’ve got time to enjoy to these bad asses of the Internets:  The Westerino ShowFunkytown BayerclanSquirreling PodcastSecretly TimidGetting It Out

#Techno House music

#Techno House music

AP: Welcome to the Growing Healthy Podcast.  Today we are fortunate to have Dr. Kelsey Mills with us to talk about Menopause!!  Dr. Mills is an obstetrician and gynecologist who has extra training in the Hot topic of Menopause!  Thanks for joining us Kelsey!    KM: Thanks Alicia, it is my pleasure to chat with you today!  This is a topic that can get women all fired up!     AP: Why don’t we start with the basics; what is menopause?     KM: That’s a great place to start.  Menopause is defined as the permanent absence of menstrual periods for one year, in the absence of other reasons for a period to stop, such as pregnancy. We have had a couple women tricked into thinking they were in menopause when in fact they were pregnant!      AP:  What a surprise that would be!!! Can you tell us a little more about Menopause.      KM: The average age of menopause in Canada is 51.4 and anything after 40 is in fact in the realm of normal. If a woman enters menopause under the age of 40, we search for other diseases, or reasons why that could happen. In natural menopause, a woman stops having periods because her ovaries have essentially used up their pool of eggs (oocytes) and are no longer ovulating each month. Therefore, there isn’t an episode of bleeding that follows ovulation, so all bleeding stops. When women don’t ovulate anymore, there are much lower levels of circulating estrogens in their body which may or may not result in menopausal symptoms.     AP:  But the transition is not necessarily an on/off switch is it....    KM: Nope...it sure isn’t!  On average, women start to experience symptoms of perimenopause for 4-5 years prior to not getting a menstrual period any more.  These symptoms can include irregular or erratic cycles, cycles that fluctuate in heaviness (one month light, one month very heavy), mood changes, hot flashes, night sweats, sleep disturbances and vaginal dryness.       AP: I often have women coming in around that time with musculoskeletal complaints as well....    KM: There are some other common concerns that happen around the time of menopause and certainly increase with aging, like “brain fog”, memory changes, hair loss, weight gain, and muscle and joint pains.  AP:  So lets talk about the menopause-specific symptoms a bit more and how we can manage them.      KM: Great.  So I find that the symptom that bothers women the most, are what we call “vasomotor symptoms” which include the hot flashes and night sweats. We know that about 80% of women in the menopausal transition experience hot flashes, but unfortunately only about 20% of those women will seek medical attention for them. Studies have shown that women find it difficult to discuss menopausal concerns with their primary care providers, and in particular find discussing vulvo-vaginal or sexual symptoms to be the most challenging. But back to hot flashes, these are generally described as a feeling of heat starting in the chest and then spreading over the upper body, face and neck. They can be accompanied by heart palpitations and sweating, and they generally last for 2-4 minutes. Hot flashes are so interesting, because some women never experience them, and some women will flash several times an hour in menopause. Hot flashes can also be different woman to woman; some women describe a prickling or skin-crawling sensation, some women describe a sense of impending doom! This is serious stuff. Menopause researchers used to believe that hot flashes only lasted for 4-5 years, but we now know that they can last much longer, perhaps 8 years on average, and some women will flash for the remainder of their life.      AP: Are there any factors that can make it more likely that women will have worse hot flashes?     KM: Well we know obesity and smoking both increase the risk of hot flashes. Interestingly, certain ethnic backgrounds, such as being of African descent, may make a woman more likely to have hot flashes.     AP: Hot flashes can happen at night as well....often drenching beds with sweat etc.  and this leads into our next symptoms of menopause....sleep disturbance!  We know that about 40% of women struggle with sleep in the menopause transition - this can be related to hot flashes, or our next topic....mood changes - namely depression.  They can also be related to things like restless legs or sleep apnea - so please make sure you talk to your family doctor if you are having sleep disturbances as there may be some testing we need to do and something we can help you with!      KM: It is true...there are so many interconnected pieces within menopause, but we can't blame everything on it!  The mood changes can often be attributed to the perimenopausal and early post menopausal time, especially in women who have not had mood disturbances before, and in these women, we often see it improve 1-2 years after menopause.  Women with pre-existing anxiety and depression are at the most risk for worsening mood issues during the menopausal transition. Probably the number one descriptor of mood changes that I hear is an increase in a women’s “irritability”. But the midlife can be a very stressful time for women, and there are many reasons for mood changes in the midlife which may not be all attributable to hormonal changes.  AP: Vaginal dryness is often a complaint women have with menopause, can you speak about that a bit?     KM: Absolutely. This is a really important topic that I wish women felt more supported to discuss. Estrogens play an important role in our bodies and women can make several different kinds of estrogens. Tissues in a women’s vulva, vagina, lower urinary tract and bladder are very sensitive to the effects of estrogens. When those estrogens are withdrawn in menopause, this can result in something we term “genitourinary syndrome of menopause” which is a fancy name for when all those tissues become drier and less elastic. This can result in itching, bleeding, having to urinate frequently or urgently, getting recurrent urinary infections, and having pain with sexual intercourse. Unlike many other menopausal symptoms, the genitourinary symptoms often start later into menopause and will progress as a woman ages.  AP: And I also think it is important to note, that these symptoms, especially the itchiness and pain, are not always simply due to menopause, so again it is important to see your care provider to ensure it is not something else causing this!      KM: Indeed!  These changes can be very uncomfortable and distressing for women....so please do not suffer unnecessarily...come talk to us...because we can help!!! And I want to take this moment to point out that although some women may bleed in menopause because of tissue dryness, post-menopausal bleeding is never normal and other sinister causes must be ruled out. Please speak to your doctor if you are menopausal and start bleeding again. Your doctor can help you with investigations to rule out worrisome causes of post-menopausal bleeding, like certain cancers.    AP:  That’s a great reminder. Well lets chat about what we can do to help women going through menopause….    KM: First and foremost let’s talk about lifestyle modifications that women can do to help manage the menopausal transition.  Anything that cools us down can help with hot flashes - having the room at a lower temperature, using a fan, using moisture wicking sheets or clothes, dressing in layers that can easily be removed and avoiding triggers like spicy food or stress can all help. Alcohol is a huge hot flash trigger for many of my patients. And alcohol contains a lot of empty calories, so cutting back can help with weight reduction and vasomotor symptoms. We also know that excessive alcohol consumption is a risk factor for breast cancer. So that’s another important reason to stop excessive drinking. Back to the notion of weight loss, if a woman is carrying extra weight, losing weight may reduce menopausal symptoms. Another very important point is that quitting smoking can have a large impact on vasomotor symptoms, bone health and overall health for women.    AP: Beneficial for menopause and beyond!!!  Other changes that can help with mood changes, joint achiness and sleep disturbance include staying well hydrated, getting regular exercise, eating healthily and maintaining good sleep hygiene. Pulling in your support system, through what can be a challenging period in your life, is never a bad idea!! Mindfulness-based stress reduction is another tool that many women going through menopause, or other stressful times, find to be very helpful!    KM: Indeed...but most women who come to see me are suffering more than these measures can help, and that is why we often have a conversation about medications.     AP:  My understanding is that when it comes to medications, you treat based on symptom severity, so not every treatment plan is the same...is that correct?    KM: Exactly. Women are so unique. Remember that there are some menopausal women who have never had a hot flash, and some who suffer hourly!   If someone has vulvo-vaginal issues, and no other symptoms, then I will treat that, but if a woman has multiple issues the treatment plan might be much different!    AP: Shall we talk about treatment then?      KM: Yes, let’s do it. The simplest symptom to treat is vaginal dryness.  Using a good lubricant with intercourse can be enough for some women’s concerns, but others may benefit from a vaginal moisturizer or local vaginal estrogen to help with their symptoms.  Vaginal estrogens in Canada can come in the form of a cream, a vaginal suppository, or a vaginal ring that is worn daily for 3 months. Local estrogens are extremely safe and there is very minimal systemic absorption of these medications. In general, vaginal estrogens are safe for all women. They do not carry an increased risk of blood clot, or stroke. If a woman has had breast cancer, then this is a bigger conversation and I encourage her to discuss the role of local estrogens with her gynecologist and oncologist.     AP: So I have heard lots about vaginal rejuvenation.....lasers and vaginas....seems like a dangerous combination....    KM: Using lasers to treat vulvo-vaginal symptoms is a relatively new player in the menopause realm. And this is different from using lasers or surgery for cosmetic enhancement, or “rejuvenation”, of the vulva and vagina. I strongly advise women against cosmetic changes their vulva and vagina. But that is another topic for another day!  Back to menopause, there is ongoing research looking into the safety, efficacy and long-term consequences of using a laser to treat vaginal symptoms, such as dryness, in menopause. Currently, vaginal laser treatments are not covered by Pharmacare or MSP, so women pay privately to use this device.  I look forward to seeing further studies in this area so I can help women decide if investing in this treatment is appropriate and safe for them.   AP: So what if women have hot flashes as well?  Will the vaginal estrogen help those?      KM: Good question Alicia. Hot flashes are treated with either hormonal or non-hormonal systemic medications.  If hot flashes or night sweats are bothering the woman, then we will have a discussion around treatment options.  The most common treatment is an estrogen and progesterone.  There are certainly some women who should not take these medications for medical reasons, which is one of the reasons it is so important to have a good conversation with your care provider prior to starting any medications!      AP: Now you said estrogen and progesterone....isn't just estrogen the problem?      KM: In general, menopause experts believe that vasomotor symptoms are best treated with systemic estrogen. But, if we give a woman with a uterus only estrogen, we increase her risk of endometrial, or uterine cancer. The endometrium is the lining of the uterus that sloughs off every month when a woman has a period.  The reason that it sloughs off, and just doesn’t keep growing and growing is progesterone.  So to protect the lining of the uterus from thickening into a potential cancer, we use progesterone to keep the endometrium thin and healthy.     AP: I have it on good authority that progesterone can help with sleep as well!     KM: Certain forms, like micronized progesterone, are better for this than others! Many women find progesterone to be sedating, and so I always recommend that women take their progesterone at night before bed.    AP: So what is the goal with Hormone therapy?     KM: Our goal is to use the lowest dose, for an appropriate duration, to manage a woman's symptoms. This is individualized based on the woman’s symptoms.     AP: So you are not trying to get to a certain number in their hormone level?      KM: No...in fact we know that symptoms are not correlated with blood hormone levels, and I explain that to my patients by saying that a woman who has terrible hot flashes, and a woman who doesn’t know what a hot flash feels like, may have the same hormone levels! So we individualize the amount of hormone that women need (or don’t need!) based on how feel her symptoms are being controlled.  AP: So why are some practitioners checking levels, and compounding creams specific to those numbers....    KM: That’s an interesting question Alicia. Compounding hormones refers to mixing hormones in a specific base or oral preparation and then applying or ingesting those hormones. I worry about what exactly my patients are receiving when those hormones are mixed, because unlike pharmaceutical grade hormones (like pills, patches, or gels), no one is doing testing on those creams to check for components, quantities, purity, or to do batch testing. We also know that progesterone is not absorbed well across the skin, so I have major concerns when my patients come to me on progesterone creams and estrogen. No major professional organization advocates for the use of compounded hormones. Often compounded hormones are very expensive as well.     AP: So save your money and buy a new pair of shoes?     KM: Or hormones that work!    AP: Back to business.....So how can the estrogen and progesterone be taken?     KM: Well, once a woman identifies that she would like treatment for her vasomotor symptoms, we first consider reasons why it may not be safe to take systemic hormones. Although hormone therapy is extremely safe, we know that in certain cases, using menopausal hormone therapy may increase women’s chances of a blood clot, stroke and breast cancer. This is particularly true of older women, for example, over the age of 60 who have multiple health problems. After evaluating these risks, we generally prefer transdermal estrogen, which is estrogen that is given through the skin in a gel or patch. We believe that this lowers the stroke and blood clot risk associated with estrogens. Most of my patients (if they have a uterus), will use a micronized progesterone to protect their uterus and help with sleep. The exact doses and types of hormone therapy are often individualized to the woman.  AP: So we know that the HRT can help with some of the mood disturbance, but what if that is the main complaint as opposed to hot flashes?      KM: Well this is a topic you are probably better at managing than I am!! Treat the mood disturbance!! Although there are a few antidepressants that have shown some efficacy in improving hot flashes as well, so if women are suffering from mood disturbance and hot flashes and are not able to take HRT for some reason, we will try one of these medications to help manage both.  These medications include Paroxetine, Venlafaxine and Desvenlafaxine.  Now if you are on an antidepressant and not significantly affected by hot flashes, I would not switch to one of these, but if you have hot flashes, and your doctor is talking about starting an antidepressant, you could consider starting with one of these. Mood changes in menopause are not an indication for starting hormone therapy.      AP: Right, and remembering managing any mood disturbance the best place to start is talking and lifestyle optimization!  So talk to your doctor, talk to a counsellor or friend if possible, pull in your support system.  Get outdoors and exercise, make sure you are following a healthy way of eating, staying hydrated and minimizing alcohol.      KM:  Before we wrap up I just wanted to chat a bit about "natural/herbal" medication in menopause care because this is something I see a lot of. In general, I tell women that if they are using a herbal supplement and they find it helpful, then it is likely a fairly low risk thing to do. The studies show that most herbal supplements in menopause have a strong placebo effect, and women generally find their symptoms return around the 3 month mark. I see a lot of women who have tried all of the herbal supplements and not had relief of their symptoms. I once had a patient come to my office with a laundry basket full of supplements! She had tried everything, and was still having terrible hot flashes. This is common and your care provider can help you discuss medical options to help manage your symptoms more effectively.   AP: Great!  Well thanks for coming and chatting about Menopause with me....something to look forward to in the coming years!!   Keep on Growing Healthy.

On MIA Radio this week, Akansha Vaswani and Dr Peter Groot discuss Tapering Strips, a novel and practical solution for those who wish to taper gradually from a range of prescription drugs. Akansha is a doctoral candidate at the University of Massachusetts, Boston and her dissertation research will involve interviewing psychiatrists in the US about their experiences helping people stop or reduce their dose of antidepressant medication. Dr Groot is a researcher and geneticist who has led the development of Tapering Strips. In a recent study, published in the journal Psychosis, Dr Groot, together with Jim van Os, reported on the results of their trial which recorded the experiences of people using Tapering Strips. In this episode we discuss: What motivated Peter to be interested in and study the effects of coming off antidepressants drugs. That the observational study reported in Psychosis was based on questionnaires completed by users who had made use of tapering medication (Tapering Strips) to slowly reduce their medication dosage. How the questionnaire asked about withdrawal symptoms and the ease of tapering using the strips and whether people had tried to withdraw previously using conventional methods. That Tapering Strips offer a flexible and necessary addition to standard doses that have been registered by the pharmaceutical companies. That current guidelines advise doctors to let patients start on the same recommended dose of an antidepressant, without taking into account large differences that exist between patients (weight, sex, etc). How we would be surprised if, when we came to buy shoes or clothes, our choices were limited to only a few sizes, but we don’t question this limitation with our medications. How current guidelines are based on group averages and do not help a doctor to determine how a given individual patient should taper. How shared decision making, in which the patient and the doctor work in a collaborative way, can make tapering easier. How shared decision making has contributed to the success of the use of tapering medication and the availability of tapering medication makes shared decision making practically possible. How shared decision and the availability of tapering medication makes life easier for the doctor as well as for the patient. How working initially as a volunteer to develop Tapering Strips brought Peter into contact with Professor Jim van Os and the User Research Centre of Maastricht University. That, in the study, 1,750 questionnaires were sent, with 1,164 received, a response rate of 68%. Of those returned, 895 said their goal was to taper their antidepressant drug completely and 70% succeeded in this goal. That the median time taken for people in the study to withdraw from Venlafaxine was 56 days or two Tapering Strips. There were a variety of reasons reported for those who didn’t reach their goal, including the fact that some of the patients were still tapering. Other reasons reported for not withdrawing completely were due to the occurrence of withdrawal symptoms, relapse of an original condition or even issues related to reimbursement of the cost of the tapering medication by insurance companies. That 692 patients reported that previous attempts to withdraw had failed in comparison to the successful use of Tapering Strips. That people using multiple drugs should only ever taper one medication at a time and in discussion with a medical professional. That Peter’s goal for Tapering Strips is to make sure that people that want to withdrawal gradually can access Tapering Strips and have the cost reimbursed by health insurers. That Tapering Strips were not developed to get everyone off their antidepressant drug but to enable patients to get to a dosage that provides benefit for them (which can be zero) while minimising adverse effects. That people outside the Netherlands can get Tapering Medication, but only with a prescription signed by a certified doctor, instructions and receipt/order forms can be found at taperingstrip.org. That Tapering Strips are also available for antipsychotics, sedatives (benzodiazepines), analgesics and for some drugs other than psychotropics, like some anti-epileptic drugs, which are currently being developed. That Peter warns against tapering by taking doses on alternating days, particularly for drugs like paroxetine or venlafaxine that have a short metabolic half-life, because this will lead to more severe withdrawal symptoms. Relevant Links: Tapering Strips (website of the User Research Centre of Maastricht University) Treatment guidelines for the use of tapering strips Summary of the tapering study in the journal Psychosis (blog) Tapering Strips study from the journal Psychosis Peter Groot interviewed on Let's Talk Withdrawal Claire shares her experience with Tapering Strips (YouTube) Petition requesting use of Tapering Strips in the UK Mad in America report on Tapering strips study Prime Time for Shared Decision Making Mandatory Shared Decision Making © Mad in America 2018

This podcast reviews the randomized double-blind placebo-controlled trial reported by Boekhout et al. that evaluates venlafaxine and clonidine for the treatment of hot flashes in women with breast cancer.