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Strap in, friends, we've got a live one on our hands today. Coming at you straight from 2006/Jake's personal trauma: "Dare 2 Share" by Greg Stier. This episode, Jake and Brooke dissect the book's... imaginative uses of the English language and discuss its potential impact on a young person's relationship to Wellbutrin.Music from #Uppbeat (free for Creators!):https://uppbeat.io/t/mood-maze/trendsetterLicense code: 9OT2MTBHWWSRZP5S Hosted on Acast. See acast.com/privacy for more information.
See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog The summer of 2025, the US has experienced record heat. Most Americans have been under a severe heat warning for months, which has caused me to review the symptoms, prevention and treatment for Heat Stroke. This summer's heat was unusual, however it may recur in the future, so we must learn to deal with the effect of prolonged exposure to dangerous heat. Heat stroke is not classically a stroke as you know it, however heat stroke is a condition of a different kind, but no less deadly. The conditions that can lead to heat stroke are listed below. Please think of these signs of Heat Stroke before you go outside in severe heat. At Risk Conditions for heat Stroke: High ambient temperature High body temperature (body temp of 104 or more) High humidity, Prolonged sun exposure (more than an hour at a time) Dehydration Loss of electrolytes through sweating which can result in heart attacks, seizures delirium and can lead to death. The hot weather we have been experiencing has been prolonged and has all the qualities described above that may lead to heat stroke: Temperatures above 90 degrees Fahrenheit, High Humidity (over 50%), Bright sunshine, causing body temp to rise rapidly and continue for a long time even after a person has gone inside to cool off in air conditioning. You Should be aware of the beginning signs of heat stroke so you can remove yourself from the heat before it becomes an emergency, and you can protect your family from heat stroke. The early signs/symptoms of heat stroke include: Heavy sweating/ or no sweating at all Thirst Weakness of muscles Headache And Dizziness When you develop these symptoms, please listen to the signs your body is sending you and seek a cool place inside away from heat and sunlight. If the symptoms don't resolve quickly, then take the steps below to prevent progression of symptoms to result in heat stroke. Lie down (heat stroke can cause you lose consciousness and hurt yourself if you pass out) Drink cool but not cold water continually Drink Electrolytes (preferably products that contain Potassium, and sodium, chloride, magnesium) with every other 12oz of water. If you don't have electrolytes, Gatorade can be substituted for electrolytes (It is only Potassium). If you are unprepared and away from civilization, put several shakes of salt into a glass of cool water and drink it. Apply icepacks on the areas of the body that can cool you quickly: Underarms, groin, and neck. This will cool your body down faster than just sitting in a cool space. Don't be alone. Ask someone to sit with you in case you pass out or seize, and they can call 911 to take you to the ER. They can also make sure you continue to drink water and take electrolytes. If you feel your headache or weakness getting worse call 911 yourself. That is a late sign of Heat Stroke. Lastly, Heat stroke can make a person act out, with a temporary personality change. The affected person can hit and push the people trying to help him or her. That means they are in the late stage of heat stroke, and they need IV fluids a cooling blanket and Medical help. Remember, heat stroke can be deadly, and immediate action must be taken. If you or someone else has the following symptoms, then Call 911: passes out or seizes, gets confused and wanders around, acts out and hits or pushes has a rapid heart rate, has a bounding pulse, has either hot dry or very damp skin, complains of a headache or dizziness, nausea, vomiting rapid shallow breathing, like panting Often, they will complain of feeling cold and they shiver even though the temperature is very hot. Don't Wait! call 911! In these cases, tell the 911 operator that you suspect heat stroke. So how do you prevent heat stroke? There are many ways to prevent heat stroke, if you recognize the conditions outside will put you at risk. First determine whether you are at high risk (below are the risks). Anyone can get heat stroke but people with the following conditions will develop heat stroke faster and more severely than healthy young individuals. The following conditions should best be treated by staying in a cool area inside away from the sun. Know the Symptoms of heat stroke and follow the directions listed above. Prepare yourself for heatstroke by carrying electrolytes more water than you think you will need, plastic zip locks to put ice in if needed High Risk Medical Conditions and Medications Previous History of a Heat Stroke The biggest risk for heat stroke is having had it in the past. People who have a history of heat stroke should be extra careful to avoid going outside or exercising in the heat and humidity. They should stay inside during the heat of the day or on days that put them at risk. If you have almost had a mild form that you acted promptly and were able to avert the severe symptoms, that still makes you at risk for heat stroke. Heart Disease or other Circulatory medical conditions Diseases of the circulatory system place you at risk for getting a more severe form of heat stroke more quickly, so limit your time in the heat. Sympathetic and Parasympathetic Imbalance, from genetics or medications Disease of the sympathetic and parasympathetic nervous systems that cause excessive fluid loss due to sweating or increased body heat can cause you to develop heat stroke with less time in the heat and sun. These conditions affect your ability to sweat, which is the way humans cool themselves down. Patients with these diseases don't sweat to cool yourself down like other people. Stay inside until the temperature and humidity is safer. Age above 50 We all know that we are not as physically able as we age, even if we use testosterone pellets, so older age is a risk factor. Please limit your time outside in dangerous conditions to one hour at a time with 10 minutes or more inside a cool place before going back outside. Medications that put you at risk for heat stroke when exposed to heat and humidity You may be unaware of the risk that some medications have when it comes to heat stroke. Medications are part of our lives and most of the time we don't think about them causing problems or side effects, but many types of relatively safe medications can cause you to have heat stroke when the other folks around you are completely normal. My Experience with Heat Stroke I was playing golf in August in St. Louis, when the starting temperature at 8:30 am was 88 degrees F, and the humidity was 65%. Being me, I thought to myself,” Well I'm in good shape because I have minimal body fat and good muscles, I should be able to golf with 3 other women even in this heat.” That day the humidity increased to 80% and the temp was over 90. Then the Pro announced that we had to stay on the cart path. Well that makes golf a lot harder…,it takes twice as many steps during a round and it requires even more exertion than walking the course and dragging a bag behind you….but I'm not a quitter (but clearly I was not thinking about being sick and taking my life in my hands)…which means I was stupid! I want all of you to be smarter than I was! Right away I started sweating profusely so much so that I had to change my golf glove three times in 6 holes. I still felt ok, but I couldn't hit the ball as far as usual, and I continued to sweat. Despite 7 bottles of water, 2 with electrolytes, I started getting a headache, and then I couldn't make contact with the golf ball. My balance was off….” Uh-oh,” I thought, “it's happening”….At that point I knew I had to go inside but was far away from the club house. I continued one more hole and I was dizzy and had poor balance….so I quit, and I drove the cart back to the club house not finishing the 9 holes. I sat inside, drank water took another packet of electrolytes and put ice packs under my arms and laid down in the women's locker room until my headache was bearable, but I knew I was not going to be productive the rest of the day. It took 24 hours of lying down in a cool room, drinking quarts of water and taking electrolytes, putting ice around my neck and head, and doing nothing else! I kept thinking “why did the heat and humidity affect me and not the other 3 women?” We are all in good shape for our ages 60-70, and we all exercise and lift weights as well as play golf a few times a week, so I thought about what my risk factors were. Finally, I checked out all the medications and supplements I am on and found that some of them put me at risk! This incident made me look up the all the meds that can impact people and increase their risk of getting heat stroke. Medications That Increase Risk of Heat Stroke Diuretics- Spironolactone is a diuretic given to all women who take T pellets to prevent facial hair and acne. It can cause dehydration in hot weather unless enough water, and electrolytes are taken to replenish body fluids. Other reasons for taking a diuretic is hypertension, heart disease, swelling, and poor circulation. eg Hydrochlorothiazide (HCTZ) and Maxide are diuretics. Beta Blockers- such as Metoprolol, Propranolol slow down the heartbeat and reduce blood pressure. The actions of Beta blockers slow the cooling mechanism of the body. Antidepressants- There ae many types of antidepressants but the “Serotonin-reuptake-inhibitors” such as Lexapro, and Wellbutrin can increase the risk of Heat Stroke, but the mechanism is not known. Amphetamines like ADD medicine, Sleep Apnea drugs, and old-fashioned weight loss pills speed up the heart rate, increase baseline body temperature and decrease the body's ability to cool itself. Thyroid Replacement-Thyroid replacement increases the heat produced by muscle tissue therefore it increases body temperature. This causes a patient on thyroid to have fewer degrees to get to a critical body temperature. I will leave you with the warning that hot weather can kill you and knowing the signs and symptoms of Heat Stroke is the first step toward helping yourself and others avoid the worst consequences. If you have medical conditions or take medications that increase your risk of developing heat stroke you should spend most of your time indoors staying cool when heat and humidity is highest. I will leave you with the warning that hot weather can kill you and knowing the signs and symptoms of Heat Stroke is the first step toward helping yourself and others avoid the worst consequences. If you have medical conditions or take medications that increase your risk of developing heat stroke you should spend most of your time indoors staying cool.
Mental health conditions and addiction are deeply intertwined, creating complex treatment challenges that require addressing both simultaneously. Dr. Mark Hrymoc, an addiction psychiatrist, shares insights on effectively treating dual diagnosis patients through parallel treatment plans that address both substance use and underlying mental health conditions.• Dual diagnosis (co-occurring disorders) describes patients with both mental health conditions and substance use disorders• Many patients use substances to self-medicate underlying mental health conditions rather than for euphoria• 50-80% of patients with addiction also have PTSD or significant trauma histories• SSRIs like Zoloft and Lexapro are first-line treatments for anxiety disorders including PTSD• Prazosin is effective for PTSD-related nightmares• Propranolol, clonidine, and gabapentin offer non-addictive options for anxiety management• ADHD is a major risk factor for developing substance use disorders• Non-stimulant options like Strattera, Qelbree, and Wellbutrin should be tried first for ADHD with comorbid addiction• Insomnia treatment options include trazodone, mirtazapine, quetiapine, and newer DORA medications• Ketamine therapy shows promise for treatment-resistant depression and suicidalityRemember, treating addiction saves lives.To contact Dr. Grover: ammadeeasy@fastmail.com
It's amazing how much smarter everyone else gets when I take antidepressants. It makes sense that the drugs work on other people, because there's nothing in me to fix. I am a perfect and wise arbiter of not only my own behavior but everyone else's, which is a heavy burden because some of ya'll are terrible at life. You date the wrong people. You take several seconds longer than necessary to order at the bagel place. And you continue to have terrible opinions even after I explain the right one to you. But only when I'm depressed. When I'm not, everyone gets better at merging from two lanes to one. This effect is not limited by the laws of causality or time. Before I restarted Wellbutrin, my partner showed me this song. My immediate reaction was, “This is fine, but what if [...] ---Outline:(04:39) Caveats(05:27) Acknowledgements--- First published: October 9th, 2025 Source: https://www.lesswrong.com/posts/FnrhynrvDpqNNx9SC/i-take-antidepressants-you-re-welcome --- Narrated by TYPE III AUDIO. ---Images from the article:Apple Podcasts and Spotify do not show images in the episode description. Try Pocket Casts, or another podcast app.
On Day 9 of Sean "Diddy" Combs' federal trial, former personal assistant George Kaplan delivered compelling testimony that shed light on the inner workings of Combs' operations. Kaplan recounted an incident aboard a private jet in 2015, where he witnessed Combs allegedly assaulting singer Cassie Ventura. According to Kaplan, he heard glass shattering and saw Combs standing over Ventura, who was on her back with her legs up, seemingly trying to create space. Ventura reportedly screamed, "Isn't anybody seeing this?" as the altercation unfolded. Kaplan also described another episode where he observed Ventura with bruises under her eye, after which Combs instructed him to purchase over-the-counter remedies to conceal the injuries .Beyond these incidents, Kaplan detailed his responsibilities, which extended beyond typical assistant duties. He testified about preparing hotel rooms for Combs' events, ensuring they were stocked with specific items and later cleaning them to protect Combs' public image. Kaplan also mentioned procuring drugs like MDMA for Combs and maintaining a "medicine bag" containing substances such as ketamine and Wellbutrin. Despite expressing admiration for Combs, Kaplan stated that he ultimately resigned in December 2015 due to discomfort with the physical behavior he witnessed .On Day 9 of Sean "Diddy" Combs' federal sex trafficking and racketeering trial, rapper Kid Cudi (Scott Mescudi) delivered a compelling testimony detailing a series of unsettling events he attributed to Combs' jealousy over Cudi's brief relationship with Casandra "Cassie" Ventura in 2011. Cudi recounted receiving a distressed call from Ventura, warning him that Combs had discovered their relationship and had obtained Cudi's home address. Subsequently, Cudi found his Los Angeles home broken into, with Christmas gifts unwrapped and his dog locked in a bathroom. He reported the incident to the police. Weeks later, in early 2012, Cudi's Porsche was destroyed by a Molotov cocktail in his driveway—a retaliatory act he suspected was orchestrated by Combs. Although Combs later denied involvement during a meeting at a Los Angeles hotel, Cudi testified that he believed the incidents were meant to intimidate him.Cudi's testimony aligns with previous allegations made by Ventura in her 2023 lawsuit, where she claimed Combs threatened violence against both her and Cudi upon learning of their relationship. During his testimony, Cudi described Combs' demeanor during their confrontation as reminiscent of a "Marvel supervillain," noting his calmness and the unsettling nature of the encounter. These accounts contribute to the prosecution's narrative of Combs' alleged pattern of coercive and violent behavior to maintain control over individuals in his personal and professional life. Combs has pleaded not guilty to all charges, including racketeering conspiracy and sex trafficking, and faces the possibility of life imprisonment if convicted.Mylah Morales testified about a 2010 incident at the Beverly Hills Hotel during the Grammy Awards weekend. She recounted waking up to the sounds of a heated argument between Combs and Cassie Ventura. After Combs stormed out of the room, Morales found Ventura with visible injuries, including a swollen lip, a black eye, and knots on her head. Concerned for Ventura's safety, Morales took her to her own home and consulted a doctor friend, who advised that Ventura should visit the emergency room. However, Ventura declined to seek medical attention or involve the police. Morales expressed fear for her own safety, stating she was afraid of Combs and feared for her lifeFrederic Zemmour, manager at the L'Ermitage Hotel in Beverly Hills, also testified on Day 9. He stated that Combs' customer profile had several notes to staff, including one that warned he "always spills candle wax on everything and uses excessive amounts of oil." These details were presented to illustrate Combs' behavior and its impact on hotel staff and property.to contact me:bobbycapucci@protonmail.comsource:May 22, 2025 - Day 9 of testimony in the Sean ‘Diddy' Combs trial | CNN
Sloppy favorites Darby and Alexis join Meatball and Big Dipper for yet another chaotic episode! They discuss tiny t shirts, fog eating, and what it means to be a headliner. Plus they get into some deep role playing scenarios exploring what a confrontation between Alexis and Raven would look like.Go see the IMHO girls on tour this fall!linktr.ee/imhotheshowSubscribe to our new YouTube channel@sloppysecondsshowListen to Sloppy Seconds Ad-Free AND One Day Early on MOM PlusCall us with your sex stories at 213-536-9180!Or e-mail us at sloppysecondspod@gmail.comFOLLOW SLOPPY SECONDSFOLLOW BIG DIPPERFOLLOW MEATBALLSLOPPY SECONDS IS A FOREVER DOG AND MOGULS OF MEDIA (M.O.M.) PODCASTSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Brendan chats this week with comedian Rosebud Baker! They talk about manifestos, starting Wellbutrin, and the future of comedy. They sing a song about an obsessive painter and write a mole people musical. Watch Rosebud's special "THE MOTHER LODE" on Netflix! FOLLOW ROSEBUD: Tickets: https://www.rosebudbaker.com/ Instagram: https://www.instagram.com/rosebudbaker/ YouTube: https://www.youtube.com/user/rosebudbaker TikTok: https://www.tiktok.com/@rosebudbaker Facebook: https://www.facebook.com/RosebudBakerNYC/ JOIN THE PATREON FOR BONUS EPS EVERY WEEK: patreon.com/sagdaddydapod WATCH BRENDAN'S SPECIAL "THIN LIPS": https://youtu.be/HpA3u7ZctsY SUBSCRIBE TO THE POD ON YOUTUBE: https://www.youtube.com/@BrendanSagalow Who do you want to see on the show next? Got topic ideas? Email us at sagdaddydapod@gmail.com. FOLLOW BRENDAN: Tickets: https://punchup.live/brendansagalow Instagram: https://www.instagram.com/brendansagalow X: https://x.com/BrendanSagalow TikTok: https://www.tiktok.com/@brendansagalow Facebook: https://www.facebook.com/Brendansagalow4 YouTube: https://www.youtube.com/@BrendanSagalow FOLLOW NICOLE: Instagram: https://www.instagram.com/nicoleclyons/ Produced by Nicole Lyons Productions Instagram: https://www.instagram.com/nicolelyonsproductions/ Website: www.nicolelyonsproductions.com Credits: Theme Song: Brendan Sagalow and Linds Cadwell Show Art: Doctor Photograph Learn more about your ad choices. Visit megaphone.fm/adchoices
For those who have tried everything to help with depression, board-certified psychiatrist Dr. Nadia Bening offers transcranial magnetic stimulation (TMS), a non-invasive, FDA-approved therapy that targets the prefrontal cortex to help reset brain activity.Specializing in treatment-resistant depression, Dr. Bening is passionate about raising awareness for TMS. With minimal side effects, it can be life-changing for people who haven't found relief with medications like SSRIs.Sessions are quick (typically under 20 minutes), require no downtime, and are often covered by insurance. Dr. Bening's experience is that many people start feeling better within two weeks. Dr. Bening sees patients across multiple Austin-area locations, including Burnet, Killeen, Dripping Springs, Fredericksburg, Canyon Lake, and Marble Falls.To learn more about Dr. Nadia BeningFollow Dr. Bening on Instagram @texashillcountrytmsABOUT MEET THE DOCTOR The purpose of the Meet the Doctor podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you're interested in. There's no substitute for an in-person appointment, but we hope this comes close.Meet The Doctor is a production of The Axis. Made with love in Austin, Texas.Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book a free 30 minute recording session at meetthedoctorpodcast.com.Host: Eva Sheie Assistant Producers: Mary Ellen Clarkson & Hannah BurkhartEngineering: Spencer ClarksonTheme music: A Grace Sufficient by JOYSPRING
A woman was very intoxicated from drinking and an argument with her husband led to her making a terrible choice that almost ended her life...
When I was struggling in my 20s, I would receive a $50 check from my dad every week. It would come from Gene Stone's Janitorial Service. He's dead now, and he would never want to be remembered that way. He was a jazz drummer, after all, and that is what he wanted people to know about him. But he also had a janitorial service where he would clean office buildings owned by his friend Dave from high school. Dave made it big in real estate and threw my dad a bone by giving him a reliable route to clean his office buildings. My dad needed the money, so he went every day on his route, cleaning toilets, washing down countertops, and vacuuming the carpets in low-rent buildings deep in the San Fernando Valley.I know the route because he gave it to me when I was a struggling single mom who wanted to raise my baby and not put her in daycare. And for a time, I worked as a janitor so I could bring my baby with me. It was honest work, except for those few individuals who seemed to take pleasure in ruining a bathroom in ways that no one would ever say out loud, much less write about in a Substack post. But I cleaned them, and I did the best job I could to make my pops proud and not embarrass him in front of his friend Dave. Now, we see the Gavin Newsom meme factory being praised by the media and the Left, for making fun of janitors.They think they're just doing what MAGA does, making fun of people. They make fun of Scott Pressler by calling him Nancy Mace. They make fun of Trump's assassination and the bandage. Except, as usual, the pod people have it wrong. Trump doesn't make fun of janitors. He doesn't make fun of gay men. Rick Grenell, the so-called “janitor,” is gay.Not only doesn't Trump make fun of the underclass, but he also took over the Kennedy Center and now the Smithsonian to do what our cultural overlords would never do: open up America's culture to everyone. As it is, both of these government institutions have served the upper-class whites who need absolution for their sins of wealth and privilege, so they virtue signal with social justice to shame all of those bad people over there who do not “believe” in their colonization origin story.I know what it is to be among the sneering class. I know what it is to virtue signal. I know what it feels like to be a “white savior” and how, for years, that was the only way people like me could feel any sort of purpose or worth. Because otherwise, we were just another “white supremacist.”I also know how this ideology benefited those at the top, and how ashamed I once was that my dad was once a janitor. Because, like all of those in Hollywood and everywhere else in American culture, what you want is to be part of the rarified elite, no janitors allowed. As long as you virtue signal, you are seen as “good” and “pure.”Well, not anymore. Newsom's desperate bid to unseat America's alpha male is reminiscent of a jungle fight between two silverback gorillas. My money is on Trump. For ten years, the Left has tried to mock him, humiliate him, defeat him, and all they got for it was a lousy White Dudes for Harris t-shirt and a humiliating loss in November of 2024.Trump has made a fool of every Democrat for ten years, and he'll make a fool of Gavin Newsom, too. Although he might not have to. The way it looks to me is like watching George Bailey and his future wife dance at the edge of the pool, not realizing they're about to fall in. They think the cheering is for the dancing.Newsom's obsession with Trump has reached almost stalker-level. He so badly wants to be Trump that he'll stop at nothing, it seems, and is perfectly happy to abandon the moral high ground to get there. But, as usual, because the Left can't meme, he's doing it wrong. Their imitation of Trump and MAGA is off because they are depicting the version they see, not the version that exists. They don't get it that much of what drove Trump's popularity was empathy. People like me couldn't stand watching their endless obsession, the unending hatred, the nonstop attacks. That's partly why I left the party. And all they're doing now is helping to rally MAGA once again. Newsom is a try-hard pick-me. He is the sleazy villain in a Lifetime movie. He's giving snooty college brat who bullies the nice guy. Don't forget where our hearts landed with the movie Breaking Away.He's the wrong one in a 1980s high school romcom, like James Spader in Pretty in Pink:His meme army, flying high on Adderall and Wellbutrin, probably thinks making fun of the working class is a winning pitch, and maybe it is for the upper class, who have run out of every other option. I mean, it's not like they have anything to offer the people, right?You can't feed your family with memes. They have no plan for the future, no vision, no way of governing the whole country except perhaps to throw half of us into gulags. What do they have left except to imitate what has defeated them? And when you've lost Joe Scarbrough:The party that is already too online is feeding the beast the Left has morphed into, as they have become consumed by their pathological hatred of Trump. So maybe that's right — this is exactly how to win hearts and minds of soulless sociopaths. According to Harry Enten, it's working! They're hoping mockery and bullying by a white guy who tweets in all-caps will work as political viagra to restore morale among their base. Ultimately, what they seem to crave is their own version of Trump. Newsom is so power hungry that he is happy to go along with it. But Trump is a survivor. He was raised to be a killer by a father who would not tolerate weakness. How else could he have survived two impeachments, four indictments, a felony conviction, two assassination attempts, and non-stop attacks from the empire for ten long years? By contrast, Newsom won't survive even one scandal. Listen to him try to defend stealing his friend's wife:Oh, and let's not forget when he ran like a coward from Erin Friday: First, he made headlines for saying allowing biological men to compete against biological women was “deeply unfair,” then he backtracked, because of course he did.Ben Shapiro opened his show with the latest scandal involving Newsom, who, of course, pivoted to Trump when called out:Newsom's tyrannical COVID policies destroyed the minds of children, not to mention small businesses. We watched them all close down. He kept students locked down longer than he should have. And that cost California a $2 billion settlement for students hurt by the lockdowns, and there is no way to recover what they've lost. Besides, Sheriff Chad Bianco is hot on Newsom's heels, highlighting the governor's obvious weakness when it came to leading California through a crisis. Newsom is now in a mad scramble to prevent gas prices from soaring to $8 per gallon. Environmental groups are coming for him, just as the LGBTQIA lobby came for him. He'll cave because he's spineless. His biggest problem is that he can't meme his way out of being a white, heteronormative male in a party that supposedly speaks to the marginalized. Gen Z, Black voters, and women will need to be on board for Newsom to win the primary. If Newsom and Kamala Harris, for instance, or even AOC, go head-to-head, then they will be at war with themselves. Who are we, they will ask, are we the party that can only win with white men? Or are we the party that wants to make history?Either way, in focusing only on the soulless bullies in his party, Newsom will have a hard time selling his own rotten policies to the Rust Belt. He won't be running against Trump. He'll be running against JD Vance. I'd bet the farm on JD. Why? Because he came from nothing, survived an abusive, drug addicted mother, fought to defend our country, and wrote a brilliant book about forgotten America.And the more they boo him, like they did at the Kennedy Center…Or kick him out of restaurants, as they did in Scotland, the more likely people like me will stand up for him and stand behind him.JD's success was earned, Newsom's was not. Just as Newsom hides behind his zillennials who do his meming for him, he will have to rely on the legacy media to transform him from a cipher into a man of substance.But if you're making fun of janitors, you're making fun of my dad and others like him who didn't have a powerful aunt in San Francisco but had to make money the old-fashioned way - they had to earn it. No one who makes fun of janitors should ever be President of the United States.The hardest work Newsom has ever done is slicking back his hair for a photo op. He's survived nothing. He's built nothing. He stands for nothing. And in that way, he's the perfect representative for today's Democratic Party. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sashastone.com/subscribe
You may think that postpartum depression covers all aspects of perinatal mental health issues that new mothers face. The fact is that there are other kinds of mood changes, some that are talked about and some that are relatively unknown and uncommon. Today's show focuses on one specific problem that some mothers experience: it's called D-Mer, which stands for Dysphoric Milk Ejection Reflex. Heidi Koss, MA, LMHC, is a psychotherapist in private practice in Redmond, WA. She specializes in perinatal (pregnancy and postpartum) mood disorders, birth trauma, sexual abuse, and parent adjustment issues. Heidi has been the WA State Coordinator for Postpartum Support International www.postpartum.net, and has volunteered for over 20 years with Perinatal Support Washington www.perinatalsupport.org. She served as past board member for PATTCh – the Prevention and Treatment of Traumatic Childbirth, www.pattch.org. Heidi is active leading trainings for clinicians on appropriate assessment and treatment options for perinatal mood disorders and birth trauma. She leads monthly clinical consult groups mentoring mental health care providers to develop their competency and expertise in perinatal mental health issues. Heidi was a co-founder of the Northwest Association for Postpartum Support (NAPS, www.napsdoulas.com) a postpartum doula organization as well as the recipient of the Doulas of North America (DONA) Penny Simkin Doula Spirit and Mentorship Award. Prior to her psychotherapy career, Heidi was a Postpartum Doula and Certified Lactation Educator for 12 years. Show Highlights: Heidi's work as a mother and perinatal mental health therapist and lactation educator: ”Helping moms with mind, body, and breast” Why D-Mer is not often talked about and often misunderstood What D-Mer is: Dysphoric Milk Ejection Reflex. It occurs when milk onset/letdown happens and lasts a few seconds or minutes D-Mer is a strange emotional phenomenon with negative emotions of sadness, dread, despair, nervousness, anxiety, and irritability D-Mer can be severe, with fleeting suicidal thoughts and urges for self-harm The biochemical connection is with two hormones, dopamine and oxytocin, in which they “go rogue,” misfire, or become overactive No studies have shown who is more predisposed to experience D-Mer For some women, D-Mer symptoms ease as the baby ages, but some have no change until weaning D-Mer symptoms might be harder to treat and control in women who already have a diagnosed anxiety or depression disorder What D-Mer is NOT: nausea, postpartum depression, anxiety, breastfeeding aversion---”It's NOT the mom's fault.” The best treatment is to educate women about D-Mer How some women can “talk themselves through” D-Mer episodes Ideas for easing symptoms include rewiring the stress hormones, making positive associations with breastfeeding, and positive touch (massage) General good habits for life will ease D-Mer symptoms, like mindfulness, meditation, good sleep and self-care, reduced stress, and managing blood sugar fluctuations To target dopamine, nursing locations should be aesthetically pleasing to make a pleasant mental and physical experience for the mother Some women find D-Mer intolerable and decide to wean, while some can deal with the symptoms and continue to breastfeed Wellbutrin works for some women to ease the symptoms How to find support: Find a lactation consultant and pursue therapy with a perinatal mental health therapist Resources: www.d-mer.org www.heidikoss.com Email Heidi: heidi@heidikoss.com Learn more about your ad choices. Visit podcastchoices.com/adchoices
Based on the book by Dr. Leonard Sax “Boys Adrift”, this episode explores Dr. Leonard Sax's research on the crisis facing young men—and what parents can do to turn the tide.--The PursueGOD Family podcast helps you think biblically about marriage and parenting. Join Bryan and Tracy Dwyer on Wednesday mornings for new topics every week or two. Find resources to talk about these episodes at pursueGOD.org/family.Help others go "full circle" as a follower of Jesus through our 12-week Pursuit series.Click here to learn more about how to use these resources at home, with a small group, or in a one-on-one discipleship relationship.Got questions or want to leave a note? Email us at podcast@pursueGOD.org.Donate Now --Based on the book “Boys Adrift” by Dr. Leonard Sax Dr. Leonard Sax, a family physician and psychologist, has spent decades researching a troubling cultural trend: boys in America are becoming increasingly apathetic, while girls continue to thrive. College enrollment numbers are down, motivation is plummeting, and a growing number of boys seem to be disengaging from real life. What's going on?A Look at the NumbersCollege statistics reflect the shift. In 2023, men made up only 42% of students aged 18–24 in four-year colleges, down from 47% in 2011. Women were 9 percentage points more likely to be enrolled in college than men in 2022. And when boys do go to college, they are less likely than girls to graduate.Brain Development and Early EducationBrain development plays a role, too. Girls' brains mature faster than boys', especially in areas related to sensory integration and self-regulation. This biological reality clashes with today's academic environment, where even kindergarten demands early reading and writing skills—before many boys are ready.5 Key Factors Behind the CrisisAccording to Dr. Sax, several powerful cultural shifts over the last 40 years are affecting boys in ways that parents and educators can no longer ignore. Dr. Sax identifies five key factors that are contributing to this downward spiral:1. Early Education Isn't Built for BoysKindergarten used to be a place for creativity and play. Now, it focuses on reading, writing, and sitting still for long periods—an environment where many boys struggle. Instead of adapting the system, society too often labels boys with ADHD. The CDC reports that over 11% of children aged 5–17 have been diagnosed with ADHD, often as a result of mismatched expectations rather than true disorder.2. Video Games Offer an Addictive EscapeMany boys say school is boring and can't wait to get home to their video games. These games offer fast-paced stimulation and constant action—but research shows they also increase risky behavior, diminish empathy, and disconnect boys from real-life goals.3. Overuse of ADHD MedicationsStimulant medications like Adderall and Ritalin can alter motivation and personality by impacting brain receptors. Dr. Sax recommends non-stimulant alternatives like Strattera or Wellbutrin, warning that reliance on the wrong medications may do more harm than good.4. Chemical Hormone DisruptionModern plastics and water contaminants act as endocrine disruptors, mimicking estrogen in the body. This not only affects puberty and hormone development in boys but may also contribute to rising ADHD rates and declining motivation.5. Lack of Strong Role ModelsFrom sitcoms to social media, positive portrayals of fatherhood and masculinity have disappeared. Instead...
Welcome or welcome back to Authentically ADHD, the podcast where we embrace the chaos and magic of the ADHD brain. Im carmen and today we're diving into a topic that's as complex as my filing system (which is to say, very): ADHD and its common co-occurring mood and learning disorders. Fasten your seatbelts (and if you're like me, try not to get distracted by the shiny window view) – we're talking anxiety, depression, OCD, dyslexia, dyscalculia, and bipolar disorder, all hanging out with ADHD.Why cover this? Because ADHD rarely rides solo. In fact, research compiled by Dr. Russell Barkley finds that over 80% of children and adults with ADHD have at least one other psychiatric disorder, and more than half have two or more coexisting conditions. Two-thirds of folks with ADHD have at least one coexisting condition, and often the classic ADHD symptoms (you know, fidgeting, daydreaming, “Did I leave the stove on?” moments) can overshadow those other disorders. It's like ADHD is the friend who talks so loud at the party that you don't notice the quieter buddies (like anxiety or dyslexia) tagging along in the background.But we're going to notice them today. With a blend of humor, sass, and solid neuroscience (yes, we can be funny and scientific – ask me how I know!), we'll explore how each of these conditions shows up alongside ADHD. We'll talk about how they can be misdiagnosed or missed entirely, and—most importantly—we'll dish out strategies to tell them apart and tackle both. Knowledge is power and self-awareness is the key, especially when it comes to untangling ADHD's web of quirks and comrades in chaos. So, let's get into it!ADHD and Anxiety: Double Trouble in OverdriveLet's start with anxiety, ADHD's frequent (and frantic) companion. Ever had your brain ping-pong between “I can't focus on this work” and “I'm so worried I'll mess it up”? That's ADHD and anxiety playing tango in your head. It's a double whammy: ADHD makes it hard to concentrate, and anxiety cranks up the worry about consequences. As one study notes, about 2 in 5 children with ADHD have significant problems with anxiety, and over half of adults with ADHD do as well. In other words, if you have ADHD and feel like a nervous wreck half the time, you're not alone – you're in very good (and jittery) company.ADHD and anxiety can look a lot alike on the surface. Both can make you restless, unfocused, and irritable. I mean, is it ADHD distractibility or am I just too busy worrying about everything to pay attention? (Hint: it can be both.) Especially for women, ADHD is often overlooked and mislabeled as anxiety. Picture a girl who can't concentrate in class: if she's constantly daydreaming and fidgety, one teacher calls it ADHD. Another sees a quiet, overwhelmed student and calls it anxiety. Same behavior, different labels. Women in particular have had their ADHD misdiagnosed as anxiety or mood issues for years, partly because anxious females tend to internalize symptoms (less hyperactive, more “worrier”), and that masks the ADHD beneath.So how do we tell ADHD and anxiety apart? One clue is where the distraction comes from. ADHD is like having 100 TV channels in your brain and someone else is holding the remote – your attention just flips on its own. Anxiety, on the other hand, is like one channel stuck on a horror movie; you can't focus on other things because a worry (or ten) is running on repeat. An adult with ADHD might forget a work deadline because, well, ADHD. An adult with anxiety might miss the deadline because they were paralyzed worrying about being perfect. Both end up missing the deadline (relatable – ask me how I know), but for different reasons.Neuroscience is starting to unravel this knot. There's evidence of a genetic link between ADHD and anxiety – the two often run in the family together. In brain studies, both conditions involve irregularities in the prefrontal cortex (the brain's command center for focus and planning) and the limbic system (emotion center). Essentially, if your brain were a car, ADHD means the brakes (inhibition) are a bit loose, and anxiety means the alarm system is hyper-sensitive. Combine loose brakes with a blaring alarm and you get… well, us. Fun times, right?Here's an interesting tidbit: Females with ADHD are more likely to report anxiety than males. Some experts think this is partly due to underdiagnosed ADHD – many girls grew up being told they were just “worrywarts” when in fact ADHD was lurking underneath, making everyday life more overwhelming and thus feeding anxiety. As Dr. Thomas Brown (a top ADHD expert) points out, emotional regulation difficulties (like chronic stress or worry) are characteristic of ADHD, even though they're not in the official DSM checklist. Our ADHD brains can amplify emotions – so a normal worry for someone else becomes a five-alarm fire for us.Now, action time: How do we manage this dynamic duo? The first step is getting the right diagnosis. A clinician should untangle whether symptoms like trouble concentrating are from anxiety, ADHD, or both. They might ask: Have you always had concentration issues (pointing to ADHD), or did they start when your anxiety kicked into high gear? Also, consider context – ADHD symptoms occur in most settings (school, work, home), while pure anxiety might spike in specific situations (say, social anxiety in crowds, or panic attacks only under stress).Treatment has to tackle both. Therapy – especially Cognitive Behavioral Therapy (CBT) – is a rockstar here. CBT can teach you skills to manage worry (hello, deep breathing and logical rebuttals to “what if” thoughts) and also help with ADHD organization hacks (like breaking tasks down, creating routines). Many find that medication is needed for one or both conditions. Stimulant meds (like methylphenidate or amphetamines) treat ADHD, but in someone with severe anxiety, a stimulant alone can sometimes ramp up the jitters. In fact, children (and adults) with ADHD + anxiety often don't respond as well to ADHD meds unless the anxiety is also addressed. Doctors might add an SSRI or other anti-anxiety medication to the mix, or choose a non-stimulant ADHD med if stimulants prove too anxiety-provoking.Let me share a quick personal strategy (with a dash of humor): I have ADHD and anxiety, so my brain is basically an internet browser with 50 tabs open – and 10 of them are frozen on a spinning “wheel of doom” (those are the anxieties). One practical tip that helps me distinguish the two is to write down my racing thoughts. If I see worries like “I'll probably get fired for sending that email typo” dominating the page, I know anxiety is flaring. If the page is blank because I got distracted after one sentence... well, hello ADHD! This silly little exercise helps me decide: do I need to do some calming techniques, or do I need to buckle down and use an ADHD strategy like the Pomodoro method? Try it out: Knowledge is power, and self-awareness is the key.Quick Tips – ADHD vs Anxiety: When in doubt, ask what's driving the chaos.* Content of Thoughts: Racing mind full of specific worries (anxiety) vs. racing mind full of everything except what you want to focus on (ADHD).* Physical Symptoms: Anxiety often brings friends like sweaty palms, racing heart, and tummy trouble. ADHD's restlessness isn't usually accompanied by fear, just boredom or impulsivity.* Treatment Approaches: For co-occurring cases, consider therapy and possibly a combo of medications. Experts often treat the most impairing symptom first – if panic attacks keep you homebound, address that alongside ADHD. Conversely, untreated ADHD can actually fuel anxiety (ever notice how missing deadlines and forgetfulness make you more anxious? Ask me how I know!). A balanced plan might be, say, stimulant medication + talk therapy for anxiety, or an SSRI combined with ADHD coaching. Work closely with a professional to fine-tune this.Alright, take a breath (seriously, if you've been holding it – breathing is good!). We've tackled anxiety; now let's talk about the dark cloud that can sometimes follow ADHD: depression.ADHD and Depression: When the Chaos Brings a CloudADHD is often associated with being energetic, spontaneous, even optimistic (“Sure, I can start a new project at 2 AM!”). So why do so many of us also struggle with depression? The reality is, living with unmanaged ADHD can be tough. Imagine years of what Dr. Russell Barkley calls “developmental delay” in executive function – always feeling one step behind in managing life, despite trying so hard. It's no surprise that about 1 in 5 kids with ADHD also has a diagnosable depression, and studies show anywhere from 8% to 55% of adults with ADHD have experienced a depressive disorder in their lifetime. (Yes, that range is huge – it depends how you define “depression” – but even on the low end it's a lot.) Dr. Barkley himself notes that roughly 25% of people with ADHD will develop significant depression by adulthood. In short, ADHD can come with a case of the blues (not the fun rhythm-and-blues kind, unfortunately).So what does ADHD + depression look like? Picture this: You've got a pile of unfinished projects, bills, laundry – the ADHD “trail of crumbs.” Initially, you shrug it off or maybe crack a joke (“organizational skills, who's she?”). But over time, the failures and frustrations can chip away at your self-esteem. You start feeling helpless or hopeless: “Why bother trying if I'm just going to screw it up or forget again?” That right there is the voice of depression sneaking in. ADHD's impulsivity might also lead to regrettable decisions or conflicts that you later brood over, another pathway to depressed mood.In fact, the Attention Deficit Disorder Association points out that ADHD's impact on our lives – trouble with self-esteem, work or school difficulties, and strained relationships – can contribute to depression. It's like a one-two punch: ADHD creates problems; those problems make you sad or defeated, which then makes it even harder to deal with ADHD. Fun cycle, huh?Now, depression itself can mask as ADHD in some cases, especially in adults. Poor concentration, low motivation, fatigue, social withdrawal – these can appear in major depression and look a lot like ADHD symptoms. If an adult walks into a doctor's office saying “I can't focus and I'm procrastinating a ton,” a cursory eval might yield an ADHD diagnosis. But if that focus problem started only after they, say, lost a loved one or fell into a deep funk, and they also feel worthless or have big sleep/appetite changes, depression may be the primary culprit. On the flip side, a person with lifelong ADHD might be misdiagnosed as just depressed, because they seem down or overwhelmed. As always, timeline is key: ADHD usually starts early (childhood), whereas depression often has a more defined onset. Also, ask: Is the inability to focus present even when life's going okay? If yes, ADHD is likely in the mix. If the focus issues wax and wane with mood, depression might be the driver.There's also a nuance: ADHD mood issues vs. clinical depression. People with ADHD can have intense emotions and feel demoralized after a bad day, but often these feelings can lift if something positive happens (say, an exciting new interest appears – suddenly we have energy!). Clinical depression is more persistent – even good news might not cheer you up much. As Dr. Thomas Brown emphasizes, ADHD includes difficulty regulating emotion; an ADHD-er might feel sudden anger or sadness that's intense but then dissipates . By contrast, depression is a consistent low mood or loss of pleasure in things over weeks or months. Knowing this difference can be huge in sorting out what's going on.Now, how do we deal with this combo? The good news: many treatments for depression also help ADHD and vice versa. Therapy is a prime example. Cognitive Behavioral Therapy and related approaches can address negative thought patterns (“I'm just a failure”) and also help with practical skills for ADHD (like scheduling, or as I call it, tricking my brain into doing stuff on time). There are even specialized therapies for adults with ADHD that blend mood and attention strategies. On the medication front, sometimes a single med can pull double duty. One interesting option is bupropion (Wellbutrin) – an antidepressant that affects dopamine and norepinephrine, which can improve both depression and ADHD symptoms in some people. There's also evidence that stimulant medications plus an antidepressant can be a powerful combo: stimulants to improve concentration and energy, antidepressant to lift mood. Psychiatrists will tailor this to the individual – for instance, if someone is severely depressed (can't get out of bed), treating depression first may be priority. If the depression seems secondary to ADHD struggles, improving the ADHD could automatically boost mood. Often, it's a balancing act of treating both concurrently – maybe starting an antidepressant and an ADHD med around the same time, or ensuring therapy covers both bases.Let's not forget lifestyle: exercise, sleep, nutrition – these affect both ADHD and mood. Regular exercise, for example, can increase BDNF (a brain growth factor) and neurotransmitters that help both attention and mood. Personally, I found that when I (finally) started a simple exercise routine, my mood swings evened out a bit and my brain felt a tad less foggy. (Of course, starting that routine required overcoming my ADHD inertia – ask me how I know that took a few tries... or twenty.)Quick Tips – ADHD vs Depression:* Check Your Joy Meter: With ADHD alone, you can still feel happy/excited when something engaging happens (ADHD folks light up for interesting tasks!). With depression, even things you normally love barely register. If your favorite hobbies no longer spark any joy, that's a red flag for depression.* All in Your Head? ADHD negative thoughts sound like “Ugh, I forgot again, I need a better system.” Depression thoughts sound like “I forgot again because I'm useless and nothing will ever change.” Listen to that self-talk; depression is a sneaky bully.* Professional Help: A thorough evaluation can include psychological tests or questionnaires to measure attention and mood separately. For treatment, consider a combined approach: therapy (like CBT or coaching) plus meds as needed. According to research, a mix of stimulant medication and therapy (especially CBT) can help treat both conditions. And remember, addressing one can often relieve the other: improve your ADHD coping skills, and you might start seeing hope instead of disappointment (boosting mood); treat your depression, and suddenly you have the energy to tackle that ADHD to-do list.Before we move on, one more important note: if you ever have thoughts of self-harm or suicide, please reach out to a professional immediately. Depression is serious, and when compounded with ADHD impulsivity, it can be dangerous. There is help, and you're not alone – so many of us have been in that dark place, and it can get better with the right support. Knowledge is power and self-awareness is the key, yes, but sometimes you also need a good therapist, maybe a support group, and possibly medication to truly turn things around. There's no shame in that game.Alright, deep breath. It's getting a bit heavy in here, so let's pivot to something different: a condition that seems like the opposite of ADHD in some ways, yet can co-occur – OCD. And don't worry, we'll crank the sass back up a notch.ADHD and OCD: The Odd Couple of AttentionWhen you think of Obsessive-Compulsive Disorder (OCD), you might picture someone extremely organized, checking the stove 10 times, everything neat and controlled. When you think ADHD… well, “organized” isn't the first word that comes to mind, right?
On Day 9 of Sean "Diddy" Combs' federal trial, former personal assistant George Kaplan delivered compelling testimony that shed light on the inner workings of Combs' operations. Kaplan recounted an incident aboard a private jet in 2015, where he witnessed Combs allegedly assaulting singer Cassie Ventura. According to Kaplan, he heard glass shattering and saw Combs standing over Ventura, who was on her back with her legs up, seemingly trying to create space. Ventura reportedly screamed, "Isn't anybody seeing this?" as the altercation unfolded. Kaplan also described another episode where he observed Ventura with bruises under her eye, after which Combs instructed him to purchase over-the-counter remedies to conceal the injuries .Beyond these incidents, Kaplan detailed his responsibilities, which extended beyond typical assistant duties. He testified about preparing hotel rooms for Combs' events, ensuring they were stocked with specific items and later cleaning them to protect Combs' public image. Kaplan also mentioned procuring drugs like MDMA for Combs and maintaining a "medicine bag" containing substances such as ketamine and Wellbutrin. Despite expressing admiration for Combs, Kaplan stated that he ultimately resigned in December 2015 due to discomfort with the physical behavior he witnessed .On Day 9 of Sean "Diddy" Combs' federal sex trafficking and racketeering trial, rapper Kid Cudi (Scott Mescudi) delivered a compelling testimony detailing a series of unsettling events he attributed to Combs' jealousy over Cudi's brief relationship with Casandra "Cassie" Ventura in 2011. Cudi recounted receiving a distressed call from Ventura, warning him that Combs had discovered their relationship and had obtained Cudi's home address. Subsequently, Cudi found his Los Angeles home broken into, with Christmas gifts unwrapped and his dog locked in a bathroom. He reported the incident to the police. Weeks later, in early 2012, Cudi's Porsche was destroyed by a Molotov cocktail in his driveway—a retaliatory act he suspected was orchestrated by Combs. Although Combs later denied involvement during a meeting at a Los Angeles hotel, Cudi testified that he believed the incidents were meant to intimidate him.Cudi's testimony aligns with previous allegations made by Ventura in her 2023 lawsuit, where she claimed Combs threatened violence against both her and Cudi upon learning of their relationship. During his testimony, Cudi described Combs' demeanor during their confrontation as reminiscent of a "Marvel supervillain," noting his calmness and the unsettling nature of the encounter. These accounts contribute to the prosecution's narrative of Combs' alleged pattern of coercive and violent behavior to maintain control over individuals in his personal and professional life. Combs has pleaded not guilty to all charges, including racketeering conspiracy and sex trafficking, and faces the possibility of life imprisonment if convicted.Mylah Morales testified about a 2010 incident at the Beverly Hills Hotel during the Grammy Awards weekend. She recounted waking up to the sounds of a heated argument between Combs and Cassie Ventura. After Combs stormed out of the room, Morales found Ventura with visible injuries, including a swollen lip, a black eye, and knots on her head. Concerned for Ventura's safety, Morales took her to her own home and consulted a doctor friend, who advised that Ventura should visit the emergency room. However, Ventura declined to seek medical attention or involve the police. Morales expressed fear for her own safety, stating she was afraid of Combs and feared for her lifeFrederic Zemmour, manager at the L'Ermitage Hotel in Beverly Hills, also testified on Day 9. He stated that Combs' customer profile had several notes to staff, including one that warned he "always spills candle wax on everything and uses excessive amounts of oil." These details were presented to illustrate Combs' behavior and its impact on hotel staff and property.to contact me:bobbycapucci@protonmail.comsource:May 22, 2025 - Day 9 of testimony in the Sean ‘Diddy' Combs trial | CNN
On Day 9 of Sean "Diddy" Combs' federal trial, former personal assistant George Kaplan delivered compelling testimony that shed light on the inner workings of Combs' operations. Kaplan recounted an incident aboard a private jet in 2015, where he witnessed Combs allegedly assaulting singer Cassie Ventura. According to Kaplan, he heard glass shattering and saw Combs standing over Ventura, who was on her back with her legs up, seemingly trying to create space. Ventura reportedly screamed, "Isn't anybody seeing this?" as the altercation unfolded. Kaplan also described another episode where he observed Ventura with bruises under her eye, after which Combs instructed him to purchase over-the-counter remedies to conceal the injuries .Beyond these incidents, Kaplan detailed his responsibilities, which extended beyond typical assistant duties. He testified about preparing hotel rooms for Combs' events, ensuring they were stocked with specific items and later cleaning them to protect Combs' public image. Kaplan also mentioned procuring drugs like MDMA for Combs and maintaining a "medicine bag" containing substances such as ketamine and Wellbutrin. Despite expressing admiration for Combs, Kaplan stated that he ultimately resigned in December 2015 due to discomfort with the physical behavior he witnessed .On Day 9 of Sean "Diddy" Combs' federal sex trafficking and racketeering trial, rapper Kid Cudi (Scott Mescudi) delivered a compelling testimony detailing a series of unsettling events he attributed to Combs' jealousy over Cudi's brief relationship with Casandra "Cassie" Ventura in 2011. Cudi recounted receiving a distressed call from Ventura, warning him that Combs had discovered their relationship and had obtained Cudi's home address. Subsequently, Cudi found his Los Angeles home broken into, with Christmas gifts unwrapped and his dog locked in a bathroom. He reported the incident to the police. Weeks later, in early 2012, Cudi's Porsche was destroyed by a Molotov cocktail in his driveway—a retaliatory act he suspected was orchestrated by Combs. Although Combs later denied involvement during a meeting at a Los Angeles hotel, Cudi testified that he believed the incidents were meant to intimidate him.Cudi's testimony aligns with previous allegations made by Ventura in her 2023 lawsuit, where she claimed Combs threatened violence against both her and Cudi upon learning of their relationship. During his testimony, Cudi described Combs' demeanor during their confrontation as reminiscent of a "Marvel supervillain," noting his calmness and the unsettling nature of the encounter. These accounts contribute to the prosecution's narrative of Combs' alleged pattern of coercive and violent behavior to maintain control over individuals in his personal and professional life. Combs has pleaded not guilty to all charges, including racketeering conspiracy and sex trafficking, and faces the possibility of life imprisonment if convicted.Mylah Morales testified about a 2010 incident at the Beverly Hills Hotel during the Grammy Awards weekend. She recounted waking up to the sounds of a heated argument between Combs and Cassie Ventura. After Combs stormed out of the room, Morales found Ventura with visible injuries, including a swollen lip, a black eye, and knots on her head. Concerned for Ventura's safety, Morales took her to her own home and consulted a doctor friend, who advised that Ventura should visit the emergency room. However, Ventura declined to seek medical attention or involve the police. Morales expressed fear for her own safety, stating she was afraid of Combs and feared for her lifeFrederic Zemmour, manager at the L'Ermitage Hotel in Beverly Hills, also testified on Day 9. He stated that Combs' customer profile had several notes to staff, including one that warned he "always spills candle wax on everything and uses excessive amounts of oil." These details were presented to illustrate Combs' behavior and its impact on hotel staff and property.to contact me:bobbycapucci@protonmail.comsource:May 22, 2025 - Day 9 of testimony in the Sean ‘Diddy' Combs trial | CNNBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-epstein-chronicles--5003294/support.
On Day 9 of Sean "Diddy" Combs' federal trial, former personal assistant George Kaplan delivered compelling testimony that shed light on the inner workings of Combs' operations. Kaplan recounted an incident aboard a private jet in 2015, where he witnessed Combs allegedly assaulting singer Cassie Ventura. According to Kaplan, he heard glass shattering and saw Combs standing over Ventura, who was on her back with her legs up, seemingly trying to create space. Ventura reportedly screamed, "Isn't anybody seeing this?" as the altercation unfolded. Kaplan also described another episode where he observed Ventura with bruises under her eye, after which Combs instructed him to purchase over-the-counter remedies to conceal the injuries .Beyond these incidents, Kaplan detailed his responsibilities, which extended beyond typical assistant duties. He testified about preparing hotel rooms for Combs' events, ensuring they were stocked with specific items and later cleaning them to protect Combs' public image. Kaplan also mentioned procuring drugs like MDMA for Combs and maintaining a "medicine bag" containing substances such as ketamine and Wellbutrin. Despite expressing admiration for Combs, Kaplan stated that he ultimately resigned in December 2015 due to discomfort with the physical behavior he witnessed .On Day 9 of Sean "Diddy" Combs' federal sex trafficking and racketeering trial, rapper Kid Cudi (Scott Mescudi) delivered a compelling testimony detailing a series of unsettling events he attributed to Combs' jealousy over Cudi's brief relationship with Casandra "Cassie" Ventura in 2011. Cudi recounted receiving a distressed call from Ventura, warning him that Combs had discovered their relationship and had obtained Cudi's home address. Subsequently, Cudi found his Los Angeles home broken into, with Christmas gifts unwrapped and his dog locked in a bathroom. He reported the incident to the police. Weeks later, in early 2012, Cudi's Porsche was destroyed by a Molotov cocktail in his driveway—a retaliatory act he suspected was orchestrated by Combs. Although Combs later denied involvement during a meeting at a Los Angeles hotel, Cudi testified that he believed the incidents were meant to intimidate him.Cudi's testimony aligns with previous allegations made by Ventura in her 2023 lawsuit, where she claimed Combs threatened violence against both her and Cudi upon learning of their relationship. During his testimony, Cudi described Combs' demeanor during their confrontation as reminiscent of a "Marvel supervillain," noting his calmness and the unsettling nature of the encounter. These accounts contribute to the prosecution's narrative of Combs' alleged pattern of coercive and violent behavior to maintain control over individuals in his personal and professional life. Combs has pleaded not guilty to all charges, including racketeering conspiracy and sex trafficking, and faces the possibility of life imprisonment if convicted.Mylah Morales testified about a 2010 incident at the Beverly Hills Hotel during the Grammy Awards weekend. She recounted waking up to the sounds of a heated argument between Combs and Cassie Ventura. After Combs stormed out of the room, Morales found Ventura with visible injuries, including a swollen lip, a black eye, and knots on her head. Concerned for Ventura's safety, Morales took her to her own home and consulted a doctor friend, who advised that Ventura should visit the emergency room. However, Ventura declined to seek medical attention or involve the police. Morales expressed fear for her own safety, stating she was afraid of Combs and feared for her lifeFrederic Zemmour, manager at the L'Ermitage Hotel in Beverly Hills, also testified on Day 9. He stated that Combs' customer profile had several notes to staff, including one that warned he "always spills candle wax on everything and uses excessive amounts of oil." These details were presented to illustrate Combs' behavior and its impact on hotel staff and property.to contact me:bobbycapucci@protonmail.comsource:May 22, 2025 - Day 9 of testimony in the Sean ‘Diddy' Combs trial | CNNBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-moscow-murders-and-more--5852883/support.
On Day 9 of Sean "Diddy" Combs' federal trial, former personal assistant George Kaplan delivered compelling testimony that shed light on the inner workings of Combs' operations. Kaplan recounted an incident aboard a private jet in 2015, where he witnessed Combs allegedly assaulting singer Cassie Ventura. According to Kaplan, he heard glass shattering and saw Combs standing over Ventura, who was on her back with her legs up, seemingly trying to create space. Ventura reportedly screamed, "Isn't anybody seeing this?" as the altercation unfolded. Kaplan also described another episode where he observed Ventura with bruises under her eye, after which Combs instructed him to purchase over-the-counter remedies to conceal the injuries .Beyond these incidents, Kaplan detailed his responsibilities, which extended beyond typical assistant duties. He testified about preparing hotel rooms for Combs' events, ensuring they were stocked with specific items and later cleaning them to protect Combs' public image. Kaplan also mentioned procuring drugs like MDMA for Combs and maintaining a "medicine bag" containing substances such as ketamine and Wellbutrin. Despite expressing admiration for Combs, Kaplan stated that he ultimately resigned in December 2015 due to discomfort with the physical behavior he witnessed .to contact me:bobbycapucci@protonmail.comsource:(5) Live updates on the Sean ‘Diddy' Combs trial: Kid Cudi on the stand following Cassie Ventura's testimony | CNN
On Day 9 of Sean "Diddy" Combs' federal trial, former personal assistant George Kaplan delivered compelling testimony that shed light on the inner workings of Combs' operations. Kaplan recounted an incident aboard a private jet in 2015, where he witnessed Combs allegedly assaulting singer Cassie Ventura. According to Kaplan, he heard glass shattering and saw Combs standing over Ventura, who was on her back with her legs up, seemingly trying to create space. Ventura reportedly screamed, "Isn't anybody seeing this?" as the altercation unfolded. Kaplan also described another episode where he observed Ventura with bruises under her eye, after which Combs instructed him to purchase over-the-counter remedies to conceal the injuries .Beyond these incidents, Kaplan detailed his responsibilities, which extended beyond typical assistant duties. He testified about preparing hotel rooms for Combs' events, ensuring they were stocked with specific items and later cleaning them to protect Combs' public image. Kaplan also mentioned procuring drugs like MDMA for Combs and maintaining a "medicine bag" containing substances such as ketamine and Wellbutrin. Despite expressing admiration for Combs, Kaplan stated that he ultimately resigned in December 2015 due to discomfort with the physical behavior he witnessed .to contact me:bobbycapucci@protonmail.comsource:(5) Live updates on the Sean ‘Diddy' Combs trial: Kid Cudi on the stand following Cassie Ventura's testimony | CNNBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-epstein-chronicles--5003294/support.
On Day 9 of Sean "Diddy" Combs' federal trial, former personal assistant George Kaplan delivered compelling testimony that shed light on the inner workings of Combs' operations. Kaplan recounted an incident aboard a private jet in 2015, where he witnessed Combs allegedly assaulting singer Cassie Ventura. According to Kaplan, he heard glass shattering and saw Combs standing over Ventura, who was on her back with her legs up, seemingly trying to create space. Ventura reportedly screamed, "Isn't anybody seeing this?" as the altercation unfolded. Kaplan also described another episode where he observed Ventura with bruises under her eye, after which Combs instructed him to purchase over-the-counter remedies to conceal the injuries .Beyond these incidents, Kaplan detailed his responsibilities, which extended beyond typical assistant duties. He testified about preparing hotel rooms for Combs' events, ensuring they were stocked with specific items and later cleaning them to protect Combs' public image. Kaplan also mentioned procuring drugs like MDMA for Combs and maintaining a "medicine bag" containing substances such as ketamine and Wellbutrin. Despite expressing admiration for Combs, Kaplan stated that he ultimately resigned in December 2015 due to discomfort with the physical behavior he witnessed .to contact me:bobbycapucci@protonmail.comsource:(5) Live updates on the Sean ‘Diddy' Combs trial: Kid Cudi on the stand following Cassie Ventura's testimony | CNNBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-moscow-murders-and-more--5852883/support.
Can medication truly transform the landscape of pediatric mental health, or are we oversimplifying the complexities of growing minds? In this episode of Pediatric Meltdown, Dr. Lia Gaggino welcomes Dr. Jess Pierce, a hospital-based child psychiatrist whose expertise bridges the worlds of pediatrics and mental health, especially for children in rural areas. Unraveling the fascinating history of psychopharmacology and delving into the mechanisms of action for the antidepressants, this episode offers a roadmap for pediatricians navigating the maze of SSRIs, SNRIs, risks like serotonin syndrome, and difficult conversations about side effects. The nuances matter and Dr. Pierce guides us skillfully.Discover why family history, patient buy-in, and transparent communications are pivotal to successful treatment—and why prescribing for young people demands a delicate blend of science, art, and empathy. This conversation will change the way you see—and approach—medication and the treatment of kids' mental health.[00:08:51] Exploring Pediatric Psychopharmacology's RootsTracing the unexpected origins of antidepressants, including how tuberculosis and hypertension treatments led to modern psychopharmacologyThe monoamine hypothesis: understanding the neurotransmitter focus in early depression treatmentsThe move beyond serotonin, dopamine, and norepinephrine: new research on neurobiology, neurogenesis, and stress responseProzac's arrival and its impact in reshaping the treatment landscape for pediatric mental health[08:52- 18:06 ] SSRIs in Practice: Similarities, Differences, and SelectionAll SSRIs share rapid absorption, high protein binding, and similar side effect profiles—but key differences can matterImportant reasons to avoid Paxil and to use Lexapro over Celexa, particularly due to side effect burdensNuanced considerations: matching specific SSRIs to individual patient needs, such as Prozac's activating profile for low-energy depressionPractical dosing strategies: the art of balancing “start low and go slow” with the urgency to help suffering children[18:07- 27:59] Navigating Risks, Side Effects, and Patient MonitoringThe truth behind the Black Box Warning: clarifying risks of suicidal ideation vs. the dangers of untreated depressionWhy regular, open conversations with families about medication side effects—especially sexual side effects in teens—build trust and adherenceRecognizing and managing serotonin syndrome: how to spot symptoms and when emergency intervention is neededIdentifying high-risk drug interactions, including situations with migraine or neurology medications[28:00-45:19 ] From SNRIs to the Five-Step Prescribing Approach and BeyondHow SNRIs differ from SSRIs in action, side effects, and indication—especially in pain syndromes or where activating effects are desiredThe use of Wellbutrin as an alternative with fewer sexual side effects, and cautions for seizure-prone populationsStrategic guidelines: the five-step approach to medication choice, considering patient history, family response, symptoms, buy-in, and comorbiditiesCritical cautions with genetic testing and the limitations of using these results to guide first-line medication choices[45:20-1:00:00] Dr Lia's TakeAwaysResources Mentioned:Dr. Pierce's PPT on Pediatric Psychopharmacology Hello! Here's the link to the slides: Psychopharm...
Chris Eckfeldt: "GOD SUSPENDED ME" | The Hopeaholics PodcastChris Eckfeldt's unforgettable journey through darkness to hope will grip your soul. In 2023, a catastrophic mountain biking accident in San Clemente shattered Chris's spine, robbing him of his legs and thrusting him into a world of unrelenting physical and emotional turmoil. Once an avid rider tearing down trails with the MTB Maniacs, he faced the stark reality of paralysis, his life forever altered in a single, harrowing moment. The protective “bubble” of rehab in Denver offered a temporary sanctuary, where logistics were managed and hope flickered. But returning home to the same streets and faces that once defined his vibrant life was a crushing awakening—every task, from bathroom access to car travel, became a labyrinth of adaptation. Job loss struck like a sledgehammer, stripping away his sense of purpose, while wrong medications, particularly Cymbalta, spiraled him into a vortex of anxiety and despair, fueling two suicide attempts that nearly ended his story. Yet, in the depths of that darkness, Chris found a lifeline. Through relentless self-advocacy, he secured the right medication—low-dose Wellbutrin—restoring clarity and stability. Bolstered by his wife Domini's unwavering support, who stood firm through fear and heartache, and a renewed faith that saw divine purpose in his survival, Chris began to rebuild. He discovered that his pain could light the way for others, not through grand gestures but through the raw, honest sharing of his journey.#TheHopeaholics #redemption #recovery #AlcoholAddiction #AddictionRecovery #wedorecover #SobrietyJourney #MyStory #RecoveryIsPossible #Hope #wedorecover Join our patreon to get access to an EXTRA EPISODE every week of ‘Off the Record', exclusive content, a thriving recovery community, and opportunities to be featured on the podcast. https://patreon.com/TheHopeaholics Follow the Hopeaholics on our Socials:https://www.instagram.com/thehopeaholics https://linktr.ee/thehopeaholicsBuy Merch: https://thehopeaholics.myshopify.comVisit our Treatment Centers: https://www.hopebythesea.comIf you or a loved one needs help, please call or text 949-615-8588. We have the resources to treat mental health and addiction. Sponsored by the Infiniti Group LLC:https://www.infinitigroupllc.com Timestamps:00:06:19 - The Mountain Biking Accident00:09:01 - The Crash and Immediate Aftermath00:10:40 - Diagnosis of Spinal Injury00:11:18 - Realizing Paralysis00:17:32 - First Suicide Attempt00:18:25 - Second Suicide Attempt00:28:53 - Job Loss as a Catalyst00:29:44 - Divine Intervention in Survival00:32:50 - Rehab as a Protective Bubble00:33:01 - Overwhelm of Returning Home00:34:23 - Medication Struggles and Advocacy00:42:28 - Support System and Treatment Commitment
A lot has been going down... allegedly. The Ladygang is diving into all the latest pop culture buzz and more! We talk about Meghan Markle's new show, odometer fraud, naturopaths, Wellbutrin, Sydney Sweeny's rumored romance with Glen Powell, and why Jessica Simpson drinks snake sperm. We also discuss Wendy Williams; Love is Blind's Mark Cuevas blindsiding his wife with a breakup post on Instagram and the smokin' hot sex appeal of Dylan Efron IRL!We have deals for YOU!!Quince: Treat yourself to luxe travel upgrades! Go to Quince.com/lady for 365-day returns PLUS free shipping on your order!Hiya Health: Your kids need good vitamins! Get 50% off at HiyaHealth.com/ladyCover Girl: Superboost your lashes with NEW Lash Blast Supercloud Mascara! Only from Easy, Breezy, Beautiful COVERGIRL. http://bit.ly/3Ez5HC9Progressive: Wanna save on car insurance? Visit Progressive.com to see how much you can save!Don't miss FX's Dying for Sex! All episodes now streaming on Hulu!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
In this Episode I compare healthcare costs and outcomes of many western countries. Then I compare Natropathic VS Alopathic medicine, and how that would fit into our current medical framework. Later I talk about Big Pharma lawsuits, and the struggle between profit and well-being. Big Pharma Lawsuits: 2001 - TAP Pharmaceutical Products - Lupron (Puberty Blocker / Cancer Drug) $875 Million - Medicare Fraud, Kickbacks 2004 - Pfizer - Neurontin (Anti Seizeure) $430 Million total - Criminal and Civil - False Claims Act 2014 - $190M again, because they didn't stop! And, another payment of $325M when the lawyers found the scope of the fraud 2007 - Amgen - Aranesp Enbrel, Neulasta (promote red blood vessel production) $612M Civil / $150M Criminal (Promoting off-label uses) 2011 - Merk - Viox (Anti-inflamitory) $950M Civil Settlement (caused heart attacks) 2012 - GlaxoSmithKline - 10 Medications Paxil, Wellbutrin, and Avandia 3 Billiion (1B Crim / 2B Civil) Falseifying Data, Promotion of Pediatric Use 2013 - Johnson & Johnson - Risperdal (antipsychotic) $1.72B Criminal / $485M Criminal (men grew breasts, not good for elderly) 2015 - Takeda - Actos (Diabetes Drug) $2.4B Civil lawsuit (Caused bladder cancer / heart attack / stroke) 2019 - Bayer & J&J - Xarelto (Blood thinner) $775m Civil (Stroke & Death) Then I look at the murder of Brandy Vaughan by Merk, and how she was an effective community organizer. In a Facebook post dated December 4 of 2019, Vaughan asks: "Ever wonder why I speak out against Big Pharma and suffer the major consequences? Because I will fight for my son and humanity and I will educate people on pharmaceutical product dangers until my last breath!” Dec 7th, 2020 Brandy Vaughan was murdered https://learntherisk.org/
Taboo to Truth: Unapologetic Conversations About Sexuality in Midlife
Low libido, or hypoactive sexual desire disorder (HSDD), can be a tough challenge for many women, particularly during midlife.In this episode, I take a closer look at the various medical treatments available for low libido, covering everything from prescription medications to hormone therapy and beyond. Whether you're dealing with hormonal shifts, relationship challenges, or simply feeling drained, this episode offers practical advice and solutions to help you regain your sexual vitality and feel more like yourself again.If this episode resonates with you, don't forget to subscribe, share with someone who might benefit, and leave a review! Let's continue the conversation and break the stigma around libido and midlife—together.Timestamps:(00:00:00) - Introduction (00:01:12) - What causes low libido?(00:02:08) - Factors contributing to low libido(00:03:19) - Overview of prescription drugs(00:04:22) - How Addyi works(00:05:33) - Vyleesi overview(00:06:34) - Viagra and Cialis for women(00:07:35) - Testosterone and hormone therapy(00:08:35) - Wellbutrin and libido(00:08:35) - Cannabis and libidoKaren Bigman, a Sexual Health Alliance Certified Sex Educator, Life, and Menopause Coach, tackles the often-taboo subject of sexuality with a straightforward and candid approach. We explore the intricacies of sex during perimenopause, post-menopause, and andropause, offering insights and support for all those experiencing these transformative phases.This podcast is not intended to give medical advice. Karen Bigman is not a medical professional. For any medical questions or issues, please visit your licensed medical provider.Looking for some fresh perspective on sex in midlife? You can find me here:Email: karen@taboototruth.comWebsite: https://www.taboototruth.com/Instagram: https://www.instagram.com/taboototruthYouTube: https://www.youtube.com/@taboototruthpodcastKaren Bigman, a Sexual Health Alliance Certified Sex Educator, Life, and Menopause Coach, tackles the often-taboo subject of sexuality with a straightforward and candid approach. We explore the intricacies of sex during perimenopause, post-menopause, and andropause, offering insights and support for all those experiencing these transformative phases.This podcast is not intended to give medical advice. Karen Bigman is not a medical professional. For any medical questions or issues, please visit your licensed medical provider.Looking for some fresh perspective on sex in midlife? You can find me here:Email: karen@taboototruth.comWebsite: https://www.taboototruth.com/Instagram: https://www.instagram.com/taboototruthYouTube: https://www.youtube.com/@taboototruthpodcastTake control of your pleasure with my Pleasure Playbook, filled with tips to help you connect with your body and enhance intimacy. Download it now at
Episode 431: Pathological Demand Avoidance in Coaching & Persistent Depression Welcome to another episode of the Hardcore Self Help Podcast with Dr. Robert Duff! In this Q&A episode, Dr. Duff tackles two insightful listener questions on very different but equally important mental health topics. Question 1: Pathological Demand Avoidance (PDA) in Coaching A listener working as an individual sports coach seeks advice on how to best support a talented but highly resistant student who displays signs of Pathological Demand Avoidance (PDA). Dr. Duff dives into: What PDA is and how it manifests in individuals, particularly in relation to autism, ADHD, and other neurodivergent conditions. The importance of reframing PDA as a high drive for autonomy rather than defiance. Practical coaching strategies to work around demand avoidance, including collaborative goal setting, offering choices, and making training sessions more engaging and playful. The significance of open-ended questions and genuine curiosity in understanding the root of a student's resistance. Question 2: Chronic Low-Grade Depression (Persistent Depressive Disorder) A listener describes their struggle with long-term, low-grade depression despite attempts with medication and therapy. Dr. Duff provides insights into: Understanding Persistent Depressive Disorder (formerly known as dysthymia) and how it differs from episodic major depression. Behavioral activation as a treatment approach, including strategies for identifying and engaging in potentially enjoyable activities despite a lack of motivation or pleasure. The five-minute rule to help overcome resistance to activities. Medication considerations, including alternatives like Wellbutrin (bupropion) and the combination drug Auvelity, which may have fewer side effects. Non-medication treatments such as Transcranial Magnetic Stimulation (TMS) and ketamine therapy. The importance of evaluating life circumstances to identify external contributors to chronic depression, such as hidden identity struggles or unsatisfying relationships. Chapters [00:00] Intro and updates on Dr. Duff's upcoming bipolar book [03:00] Question 1: Pathological Demand Avoidance (PDA) in coaching [12:00] Strategies for engaging students with PDA [14:00] Question 2: Chronic low-grade depression and treatment options [19:00] Behavioral activation and the five-minute rule [23:00] Medication alternatives and non-pharmacological treatments [27:00] Life circumstances and their role in persistent depression [28:00] Outro and listener support requests Resources & Links Dr. Duff's website: http://duffthepsych.com Email your questions: duffthepsych@gmail.com Follow Dr. Duff on Instagram: https://instagram.com/duffthepsych Dr. Duff's book “Hardcore Self Help: F**k Depression”: https://www.amazon.com/Hardcore-Self-Help-Depression/dp/B01J4H5A40 Previous episodes on TMS and ketamine treatments: http://duffthepsych.com/podcast More on ketamine treatments: https://duffthepsych.com/ect-and-ketamine/ Thank you for tuning in! If you found this episode helpful, please consider sharing it with a friend or leaving a review. Your support helps the podcast grow and reach more people who need it. See you next time!
Send us a textWhat if taking time for yourself was the key to being the best mom you can be? Join me on the Selfish Mom Podcast, where I share my personal journey of navigating weight loss, energy slumps, and a decrease in sex drive over the past two years. I candidly discuss what has and hasn't worked for me, from various diets to exploring supplements and medications. Together, we'll challenge the notion of selfishness, emphasizing that prioritizing our well-being is essential for thriving, not just surviving. Plus, I'm excited to announce plans to bring in experts like a hormone specialist and a breast implant illness doctor to enrich our understanding and empower us with knowledge.My story continues as I recount recovery and fitness battles following my three C-sections. Movement is vital during postpartum recovery, and I'll walk you through the importance of easing back into physical activity while honoring your body's limits. I open up about postpartum weight struggles, especially while nursing, and underline the importance of self-awareness and consistency in self-care. You'll hear about my experience with body changes and the realistic expectations we should set, reminding us all that every body is unique and worthy of respect.The episode wraps up with insights into managing health issues such as hormone imbalances and ADHD. My path through functional medicine, ADHD medication like Wellbutrin, and dietary shifts like the carnivore diet reveals a blend of modern and holistic approaches. I stress the importance of understanding root causes to achieve long-term health improvements. Listen to my honest reflections and learn how balancing lifestyle changes with medical interventions has helped me reclaim energy and focus. Let's redefine what it means to be "selfish" together by taking charge of our mental and physical health.Fit, Healthy & Happy Podcast Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...Listen on: Apple Podcasts SpotifySupport the show
This woman took a lot of Wellbutrin (Bupropion) and ended up in the hospital for eight days...
This week we will discuss the use of Ketamine for treating Depression. Our guest for this week's show is Karen DeCocker, DNP, PMHNP, CNM Karen DeCocker is the Director of Advanced Practice Providers at Stella overseeing the assessment team. She helps to identify which innovative biological medical treatments & virtual therapies can help relieve symptoms of anxiety, depression, PTSD & traumatic brain injury. After completing a virtual assessment of each patient, Dr. DeCocker and her team analyze the medical, biological, psychological & social factors to provide personalized treatment recommendations across Stella's advanced protocols such as Dual Sympathetic Reset (advanced stellate ganglion block), Ketamine Infusion Therapy, Transcranial Magnetic Stimulation (TMS), Spravato, integration therapy, and more. Dr. DeCocker's priority is the patient's outcome. She became a nurse practitioner in 2007 after 10 years of hospital nursing experience. As rates of depression and anxiety have increased dramatically, people have sought therapies outside the standard regimen of oral antidepressants and talk therapy. Beginning in the mid-2010s, more and more doctors started offering ketamine as a treatment for depression. In 2019, the Food and Drug Administration (FDA) approved esketamine as a treatment for forms of depression that haven't improved with standard antidepressants (like citalopram/Celexa or bupropion/Wellbutrin). (Source: Psychology Today)
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
Can depression really sabotage your sex life and relationships? Unpack the eye-opening truths behind this connection in our latest episode. We begin by exploring a 2021 study revealing a shockingly high occurrence of sexual dysfunction among those battling major depressive disorder. Learn how symptoms like anhedonia, low self-esteem, and irritability can extinguish sexual desire, and discover the paradox of antidepressants, which can sometimes make things worse. We'll discuss strategies to counteract these side effects, such as tweaking dosages or opting for alternatives like Wellbutrin, and emphasize the vital role of empathy and understanding from partners.Moving beyond the bedroom, we scrutinize how depression impacts memory and perception, causing past experiences to appear darker than they were. Hear personal stories about the relief gained from understanding concepts like confabulation and learned helplessness. We'll shed light on the neurological underpinnings, focusing on the dorsolateral prefrontal cortex and its importance in reward processing. This episode doesn't just stop at explanations—we delve into comprehensive treatments like therapy, medication, ketamine, and transcranial magnetic stimulation (TMS) that offer a path to restoring brain function and reclaiming life. Tune in to deepen your compassion and awareness for those navigating the labyrinth of depression.
In this episode of My Thyroid Health, we learn about whether Welbutrin (bupoprion), a common antidepressant, can help you lose weight and whether it's safe for thyroid patients. What you will learn: What is Wellbutrin (bupropion)? What are the side effects of Wellbutrin? Why does Wellbutrin help with weight loss? Is it safe for thyroid patients to use Wellbutrin for weight loss? What are weight-loss strategies best for hypothyroid weight gain? Check out our blog and read the full article here: https://www.palomahealth.com/learn/wellbutrin-thyroid-weight-loss About Paloma Health: Paloma Health is an online medical practice focused exclusively on treating hypothyroidism. From online visits with your provider to easy prescription management and lab orders, we create personalized treatment plans for you. Become a member, or try our at-home test kit and experience a whole new level of hypothyroid care. Use code PODCAST to save $30 at checkout. Disclaimer: The $30 discount is only valid for first-time Paloma Health members and test kit users. Coupon must be entered at the time of checkout.
#192 In this episode of 'Chemistry for Your Life,' hosts Melissa and Jam introduce special guest Claire Caballero, a pharmacology and neuroscience PhD student, to discuss how antidepressants work. Claire explains the role of neurotransmitters like serotonin, dopamine, and GABA in mental health, the mechanisms of various antidepressants such as SSRIs, tricyclic antidepressants, and monoamine oxidase inhibitors, and touches on the effects and side effects of drugs like Wellbutrin. The episode provides an insightful look at the chemistry and neuroscience behind how these medications help manage depression and anxiety. 00:00 Introduction and Special Guest Announcement 00:52 Meet Claire: Our Expert in Pharmacology and Neuroscience 01:32 Understanding Pharmacology and Neurotransmission 05:16 The Role of Neurotransmitters in Anxiety and Depression 14:16 Deep Dive into Neurotransmitters: GABA, Dopamine, and Serotonin 17:10 Exploring the Mechanisms of Depression and Anxiety 22:21 Ready to Learn About Antidepressant Drugs? 33:20 Understanding SSRIs and Their Uses 34:14 How SSRIs Work in the Brain 36:23 Challenges and Side Effects of SSRIs 43:08 Exploring Tricyclic Antidepressants 48:35 Monoamine Oxidase Inhibitors: The First Antidepressants 54:59 Benzodiazepines: Uses and Risks 01:00:01 Other Notable Drugs: Bupropion and Beta Blockers 01:05:07 Conclusion and Final Thoughts References from this episode: https://www.ncbi.nlm.nih.gov/books/NBK554406/ https://www.ncbi.nlm.nih.gov/books/NBK557791/ https://www.ncbi.nlm.nih.gov/books/NBK539848/ https://www.ncbi.nlm.nih.gov/books/NBK470159/#:~:text=Benzodiazepines%20are%20effective%20for%20sedation,potential%20to%20develop%20physical%20dependence. https://www.nami.org/about-mental-illness/mental-health-conditions/anxiety-disorders/#:~:text=Anxiety%20disorders%20are%20the%20most,develop%20symptoms%20before%20age%2021. https://mhanational.org/conditions/depression#:~:text=Major%20depression%20is%20one%20of,are%20affected%20by%20major%20depression. https://www.cdc.gov/nchs/products/databriefs/db377.htm https://www.ncbi.nlm.nih.gov/books/NBK470212/ https://www.jneurosci.org/content/28/28/7040 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303399/ https://www.ncbi.nlm.nih.gov/books/NBK551683/#:~:text=Anxiety%20disorders%20such%20as%20panic,with%20decreased%20levels%20of%20GABA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684250/#:~:text=Neuroendocrine%20and%20Neurotransmitter%20Pathways&text=Well%2Ddocumented%20anxiolytic%20and%20antidepressant,of%20mood%20and%20anxiety%20disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950973/#:~:text=The%20monoamine%2Ddeficiency%20theory%20posits,in%20the%20central%20nervous%20system. https://www.health.harvard.edu/depression/depression-chemicals-and-communication https://www.ncbi.nlm.nih.gov/books/NBK539894/ https://www.sciencedirect.com/science/article/pii/S1476179306700246?via%3Dihub https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610616/ We want to give a special thanks to Bri McAllister for illustrating molecules for some episodes! Please go check out Bri's art, follow and support her at entr0pic.artstation.com and @McAllisterBri on twitter! Thanks to our monthly supporters Scott B Jessie Reder Ciara Linville J0HNTR0Y Jeannette Napoleon Cullyn R Erica Bee Elizabeth P Sarah Moar Rachel Reina Letila Katrina Barnum-Huckins Suzanne Phillips Venus Rebholz Lyn Stubblefield Jacob Taber Brian Kimball Emerson Woodhall Kristina Gotfredsen Timothy Parker Steven Boyles Chris Skupien Chelsea B Bri McAllister Avishai Barnoy Hunter Reardon ★ Support this podcast on Patreon ★ ★ Buy Podcast Merch and Apparel ★ Check out our website at chemforyourlife.com Watch our episodes on YouTube Find us on Instagram, Twitter, and Facebook @ChemForYourLife
Have a question you want answered? Submit it here!Is Brain Fog Real? How to Beat It & Get Your Mental Clarity Back! Ever felt like you're walking through a mental fog? Forgetful, unfocused, and struggling to concentrate? You're not alone! Today, we're diving deep into the world of brain fog with the incredible Kimberly Beam Holmes.In this episode, we'll uncover:• What is brain fog? We'll break down the science, symptoms, and real-life experiences.• Why is brain fog on the rise? We'll explore the surprising link between COVID-19 and brain fog, plus other potential triggers.• How to kick brain fog to the curb! Discover the four powerful strategies you can use to reclaim your mental clarity: sleep, healthy diet, exercise, and mental breaks. We'll even reveal some bonus tips, including the potential benefits of Wellbutrin and the power of drinking water.Don't let brain fog hold you back from living your best life! Join us on this journey to understand and overcome this common struggle. Hit that subscribe button for more life-changing conversations on mental health, relationships, and personal growth. Turn on notifications so you never miss an episode! Share the love! If this video resonated with you, share it with a friend who might be struggling with brain fog. Your Host: Kimberly Beam Holmes, Expert in Self-Improvement and RelationshipsKimberly Beam Holmes has applied her master's degree in psychology for over ten years, acting as the CEO of Marriage Helper & CEO and Creator of PIES University, being a wife and mother herself, and researching how attraction affects relationships. Her videos, podcasts, and following reach over 500,000 people a month who are making changes and becoming the best they can be.
Welcome to the 35th episode in my drug name pronunciation series. In this episode, I divide bupropion into syllables, tell you which syllable to emphasize, and share my source. The written pronunciation is below and in the show notes on thepharmacistsvoice.com. Bupropion = bue PROE pee on Emphasize PROE. Source: USP Dictionary Online Thank you for listening to episode 287 of The Pharmacist's Voice ® Podcast. To read the FULL show notes (including all links), visit https://www.thepharmacistsvoice.com/podcast. Select episode 287. If you know someone who needs to learn how to say bupropion, please share this episode with them. Please subscribe for all future episodes. This podcast is on all major podcast players and YouTube. Some popular podcast player links are below. Apple Podcasts https://apple.co/42yqXOG Spotify https://spoti.fi/3qAk3uY Amazon/Audible https://adbl.co/43tM45P YouTube https://bit.ly/43Rnrjt Links from this episode USP Dictionary Online (Subscription-based resource) USP Dictionary's pronunciation guide (Free resource on The American Medical Association's website) Kim's websites and social media links: ✅Business website https://www.thepharmacistsvoice.com ✅The Pharmacist's Voice ® Podcast https://www.thepharmacistsvoice.com/podcast ✅Pronounce Drug Names Like a Pro © Online Course https://www.kimnewlove.com ✅A Behind-the-scenes look at The Pharmacist's Voice ® Podcast © Online Course https://www.kimnewlove.com ✅LinkedIn https://www.linkedin.com/in/kimnewlove ✅Facebook https://www.facebook.com/kim.newlove.96 ✅Twitter https://twitter.com/KimNewloveVO ✅Instagram https://www.instagram.com/kimnewlovevo/ ✅YouTube https://www.youtube.com/channel/UCA3UyhNBi9CCqIMP8t1wRZQ ✅ACX (Audiobook Narrator Profile) https://www.acx.com/narrator?p=A10FSORRTANJ4Z ✅Start a podcast with the same coach who helped me get started (Dave Jackson from The School of Podcasting)! **Affiliate Link - NEW 9-8-23** Pronunciation Series Links The Pharmacist's Voice Podcast Episode 285, pronunciation series ep 34 (fentanyl) The Pharmacist's Voice Podcast Ep 281, Pronunciation Series Ep 33 levothyroxine (Synthroid) The Pharmacist's Voice ® Podcast Ep 278, Pronunciation Series Ep 32 ondansetron (Zofran) The Pharmacist's Voice ® Podcast Episode 276, pronunciation series episode 31 (tocilizumab-aazg) The Pharmacist's Voice ® Podcast Episode 274, pronunciation series episode 30 (citalopram and escitalopram) The Pharmacist's Voice ® Podcast Episode 272, pronunciation series episode 29 (losartan) The Pharmacist's Voice Podcast Episode 269, pronunciation series episode 28 (tirzepatide) The Pharmacist's Voice Podcast Episode 267, pronunciation series episode 27 (atorvastatin) The Pharmacist's Voice Podcast Episode 265, pronunciation series episode 26 (omeprazole) The Pharmacist's Voice Podcast Episode 263, pronunciation series episode 25 (PDE-5 inhibitors) The Pharmacist's Voice Podcast Episode 259, pronunciation series episode 24 (ketorolac) The Pharmacist's Voice ® Podcast episode 254, pronunciation series episode 23 (Paxlovid) The Pharmacist's Voice ® Podcast episode 250, pronunciation series episode 22 (metformin/Glucophage) The Pharmacist's Voice Podcast ® episode 245, pronunciation series episode 21 (naltrexone/Vivitrol) The Pharmacist's Voice ® Podcast episode 240, pronunciation series episode 20 (levalbuterol) The Pharmacist's Voice ® Podcast episode 236, pronunciation series episode 19 (phentermine) The Pharmacist's Voice ® Podcast episode 228, pronunciation series episode 18 (ezetimibe) The Pharmacist's Voice ® Podcast episode 219, pronunciation series episode 17 (semaglutide) The Pharmacist's Voice ® Podcast episode 215, pronunciation series episode 16 (mifepristone and misoprostol) The Pharmacist's Voice ® Podcast episode 211, pronunciation series episode 15 (Humira®) The Pharmacist's Voice ® Podcast episode 202, pronunciation series episode 14 (SMZ-TMP) The Pharmacist's Voice ® Podcast episode 198, pronunciation series episode 13 (carisoprodol) The Pharmacist's Voice ® Podcast episode 194, pronunciation series episode 12 (tianeptine) The Pharmacist's Voice ® Podcast episode 188, pronunciation series episode 11 (insulin icodec) The Pharmacist's Voice ® Podcast episode 184, pronunciation series episode 10 (phenytoin and isotretinoin) The Pharmacist's Voice ® Podcast episode 180, pronunciation series episode 9 Apretude® (cabotegravir) The Pharmacist's Voice ® Podcast episode 177, pronunciation series episode 8 (metoprolol) The Pharmacist's Voice ® Podcast episode 164, pronunciation series episode 7 (levetiracetam) The Pharmacist's Voice ® Podcast episode 159, pronunciation series episode 6 (talimogene laherparepvec or T-VEC) The Pharmacist's Voice ® Podcast episode 155, pronunciation series episode 5 Trulicity® (dulaglutide) The Pharmacist's Voice ® Podcast episode 148, pronunciation series episode 4 Besponsa® (inotuzumab ozogamicin) The Pharmacist's Voice ® Podcast episode 142, pronunciation series episode 3 Zolmitriptan and Zokinvy The Pharmacist's Voice ® Podcast episode 138, pronunciation series episode 2 Molnupiravir and Taltz The Pharmacist's Voice ® Podcast episode 134, pronunciation series episode 1 Eszopiclone and Qulipta Thank you for listening to episode 287 of The Pharmacist's Voice ® Podcast. If you know someone who would like this episode, please share it with them!
In this episode of "The Vibe With Ky Podcast," I dive into the serious repercussions of stopping medication suddenly, particularly my antidepressants and ADHD meds. I share my personal story of what happened when I decided to stop taking Wellbutrin and Focalin cold turkey, the impact it had on my mental health, and why I'll never make that mistake again. --- Support this podcast: https://podcasters.spotify.com/pod/show/thevibewithky/support
A year and a half ago, I went on an antidepressant medication, Wellbutrin, which is a dopamine and norepinephrine reuptake inhibitor. After 20 years of plant medicine, meditation, therapy, and other healing modalities, which I still use, I was still experiencing persistent challenges. With the support of my advisors and my doctor, I decided to an antidepressant while maintaining my alternative healing practices. Today on the show I discuss the intersection of psychopharmacology and psychedelics with a psychiatric pharmacist, Ben Malcom. On the show, we talk about how Ben became a psychedelic pharmacist and how he created his website, Spirit Pharmacist. We discuss the origins of mental health treatment, the use of psychedelics and psychotropics together, and important contraindications for LSD, psilocybin, MDMA, ketamine, and ayahuasca. We cover the process of tapering off antidepressants, the reasons behind it, how it works, and the period needed for tapering. Ben also speaks directly to psychedelic practitioners. This is offered for informational purposes only, and I would direct you to Ben Malcolm's website for more specific answers. Ben Malcolm is a psychopharmacologist and professor of pharmacy with experience in plant medicine and psychedelics. He helps people get off psychiatric meds for journeys and is available to help you or your clients if you are in the healing arts. Ben Malcolm is a board-certified psychiatric pharmacist with a passion for psychedelic drugs, antipsychotics, antidepressants, and alternative medicines. He offers psychopharmacology consulting, educational courses, and a membership program at his website Spirit Pharmacist. Links Psychedelic Psychopharmacology Consulting and Education Spirit Pharmacist (@spiritpharmacist) Timestamps (09:30) - How Ben became a psychedelic pharmacist (14:30) - The origins of mental health treatment (21:30) - Using psychedelics with psychotropics (29:00) - Contraindications for LSD, psilocybin, MDMA, ketamine, and ayahuasca (45:00) - Tapering off antidepressants (59:00) - Ben speaks to psychedelic practitioners
The Snobs rant, rave, review, mention in passing and briefly discuss these things: (00:00:00) Intro (00:02:24) Shadows Over Camelot-https://boardgamegeek.com/boardgame/15062/shadows-over-camelot (00:04:40) can you raise one eyebrow (00:08:05) listener emails (00:20:45) Skyrise-https://boardgamegeek.com/boardgame/298231/skyrise (00:26:05) table presence/the Mentos commercial (00:30:45) Gaby stops taking Wellbutrin XL (00:34:45) why Gaby started taking Wellbutrin XL in the first place / holistic medicine /neurosis (00:46:00) Popeye's PTSD (00:47:30) sponsored by Pfizer (00:50:00) Willie Nilly 00:54:30) Den of Hughes To Join Our Patreon: https://www.patreon.com/bgsnobs Follow/join us at: Board Game Snobs Discord https://www.instagram.com/boardgamesnobs/ Board Game Snobs Facebook Group For merch: https://sirmeeple.com/collections/board-game-snobs For questions, comments or general adulation: Send emails to boardgamesnobs@gmail.com
Just when you thought things couldn't get any nerdier, Kristin is back with a follow-up lesson on ADHD medications. In part 2 she's keeping the chemistry to a minimum as she looks at the mechanisms of action and potential benefits and side effects of non-stimulant medications such as Strattera, Wellbutrin, and other fun names we can't pronounce. Also, we ponder about the nuances of frozen treats, get grubby in the garden, handle a family hacker, and listen to a quick 10 hours of soothing bird calls. Resources Atomoxetine - StatPearls - NCBI Bookshelf (nih.gov) Nonstimulant ADHD Meds: Types and Side Effects | Psych Central Viloxazine in the Treatment of Attention Deficit Hyperactivity Disorder - PMC (nih.gov) Bupropion - StatPearls - NCBI Bookshelf (nih.gov) Drug Interaction List: atomoxetine - Drugs.com Tricyclic Antidepressants - StatPearls - NCBI Bookshelf (nih.gov) https://doctorlib.info/pharmacology/stahls-essential-psychopharmacology-4/12.html The sound of the White-throated dipper - Bird Sounds | 10 Hours (youtube.com)
Curious about ADHD meds & not sure where to start? This episode covers:Understanding ADHD Medication: We explore what ADHD medication is and how it helps manage symptoms.Types of Medications: A look at stimulant and non-stimulant options and how they work.Addressing Fears: Discussing common concerns about addiction and side effects.Immediate Effects: How quickly can you notice changes, and what to expect.Personal Insights: I share my personal journey with ADHD medication, including challenges and positive changes.Advocacy and Choice: Encouraging you to advocate for yourself and discuss options with your doctor.Remember, the decision to use medication should be made with a healthcare provider. This episode aims to arm you with knowledge to make informed discussions about your health.Connect with Us:Are you a high-achieving woman with ADHD looking for a coach? Event planner looking for a wildly captivating speaker? Go to outsmartadhd.co to get in touch!
After finishing her training in neurology at Mayo Clinic, Dr. Svetlana Blitshteyn started a Dysautonomia Clinic in 2009. Little did she know what was in store many years later when Covid hit!Ground Truths podcasts are on Apple and Spotify. The video interviews are on YouTubeTranscript with audio and external linksEric Topol (00:07):Well, hello, it's Eric Topol from Ground Truths, and I have with me a really great authority on dysautonomia and POTS. We will get into what that is for those who aren't following this closely. And it's Svetlana Blitshteyn who is a faculty member at University of Buffalo and a neurologist who long before there was such a thing as Covid was already onto one of the most important pathways of the body, the autonomic nervous system and how it can go off track. So welcome, Svetlana.Svetlana Blitshteyn (00:40):Thank you so much, Eric for having me. And I want to say it's a great honor for me to be here and just to be on the list with your other guests. It's remarkable and I'm very grateful and congratulations on being on the TIME100 Health list for influential people in 2024. And I am grateful for everything that you've done. As I mentioned earlier, I'm a big fan of your work before the pandemic and of course with Covid I followed your podcast and posts because you became the best science communicator and I'm very happy to see you being a strong advocate and thank you for everything you've done.Eric Topol (01:27):Well, that's so kind to you. And I think talking about getting things going before the pandemic, back in 2011, you published a book with Jodi Epstein Rhum called POTS - Together We Stand: Riding the Waves of Dysautonomia. And you probably didn't have an idea that there would be an epidemic of that more than a decade later, I guess, right?Svetlana Blitshteyn (01:54):Yeah, absolutely. Of course, SARS-CoV-2 is a new virus and we can technically say that Long Covid and post Covid complications could be viewed as a new entity. But practically speaking, we know that post-infectious syndromes have been happening for many decades. And so, the most common trigger for POTS happened to be infection, whether it was influenza or mononucleosis or Lyme or enterovirus. We knew this was happening. So I think it didn't take long for me and my colleagues to realize that we're going to be seeing a lot of patients with autonomic dysfunction after Covid.On the Front LineEric Topol (02:40):Well, one of the things that's important for having you on is you're in the front lines taking care of lots of patients with Long Covid and this postural orthostatic tachycardia syndrome (POTS). And I wonder if you could tell us what it's care for these patients because so many of them are incapacitated. As a cardiologist, I see of course some because of the cardiovascular aspects, but you are dealing with this on a day-to-day basis.Svetlana Blitshteyn (03:14):Yeah, absolutely. As early as April 2020 when everything was closed, I got a call from a young doctor in New York City saying that he had Covid and he couldn't recover, he couldn't return to the hospital. And his colleagues and cardiology attendants also had the same symptoms and the symptoms were palpitations, orthostatic intolerance, tachycardia, fatigue. Now, how he knew to contact me is that his sister was my patient with POTS before Covid pandemic. So he kind of figured this looked like my sister, let me check this out. And it didn't take long for me to have a lot of patience from the early wave. And then fairly soon, I think within months I was thinking, we have to write this up because this is important. And to some of us it was not news, but I was sure that to many physicians and public health officials, this would be something new.Svetlana Blitshteyn (04:18):So because I'm a busy clinician and don't have a lot of time for publications, I had to recruit a graduate student from McMasters and together we had this paper out, which was the first and largest case series on post Covid POTS and other autonomic disorders. And interestingly, even though it came out I think in 2021, by the time it was published, it became the most citable paper for me. And so I think from then on organizations and societies became interested in the work that I do because prior to that, I must say in the kind of a niche specialty was I don't think it was very popular or of interest to me.How Did You Get Interested in Dysautonomia?Eric Topol (05:06):Yeah, so that's why I wanted to just take a step back with you Svetlana, because you had the foresight to be the founder and director of the Dysautonomia Clinic when a lot of people weren't in touch with this as an important entity. What prompted you as a neurologist to really zoom in on dysautonomia when you started this clinic?Svetlana Blitshteyn (05:28):Sure. So the reasons are how I ended up in this field is kind of a convoluted road and the reasons are many, but one, I will say that I trained at Mayo Clinic where we received very good training on autonomic disorders and EMG and coming back to returning back to Buffalo, I began working at the large multiple sclerosis clinic because Western New York has a high incidence MS. And so, what they quickly realized in that clinic is that there was a subset of women who did not qualify for the diagnostic criteria of multiple sclerosis, yet they had a lot of the same symptoms and they were certainly very disabled. Now I recognize that these women had autonomic disorders of all sorts and small fiber neuropathy, and I think this population sort of grew and eventually I realized there is no one not only in Buffalo but the entire Western New York who is doing this work.Svetlana Blitshteyn (06:34):So I kind of fell into that. But another reason is actually more personal that I haven't talked about. So years ago I was traveling to Toronto, Canada for a neurology meeting to present my big study on meningioma and hormone replacement therapy using Mayo Clinic database. And so, in that year, the study received top 10 noteworthy studies of the year award from the Society of Neuro-Oncology, and it was profiled in Reuters Health. Now, on the way back from the conference, I had the flu, and when they returned I could no longer walk the same hallways of the hospital where I walked previously. And no matter how hard I try to push my body, we all do this in medicine, we push through, I just couldn't do it. No amount of wishing or positive thinking. And so, I think that's how I came to know personally the post-infectious syndromes. And I think it almost became a duality of experiencing this and also practicing it.Eric Topol (07:52):No, that's really striking and it wasn't so common to hear about this post flu, but certainly it changed in 2020. So how does a person with POTS typically present to you?Clinical PresentationSvetlana Blitshteyn (08:08):So these are very important questions because what I want to stress is though POTS is one of the most common autonomic disorders. Even if you don't have POTS by the diagnostic criteria, you may still have autonomic dysfunction and significant autonomic symptoms. How do they present? Well, they present like most Long Covid patients, the most common symptoms are orthostatic intolerance, fatigue, exercise intolerance, post exertional malaise, dizziness, tachycardia, brain fog. And these are common themes across the board in Long Covid patients, but also in pre-Covid post-acute infection syndrome patients. And you have to recognize because I think what I tell my colleagues is that oftentimes patients are not going to present to you saying, I have orthostatic intolerance. Many times they will say, I'm very tired. I can no longer go to the gym or when I go to the store, I have to be out of there in 15 minutes because the orthostatic intolerance symptoms come up.Svetlana Blitshteyn (09:22):So sometimes the patients themselves don't recognize that and it's up to us physicians to ask the right questions to get the information down. History is very important, knowing the pattern. And then of course, as I always say in all of my papers and lectures, you have to do a 10-minute stand test by measuring supine and standing blood pressure and heart rate on every Long Covid patients. And that's how you spot those that have excessive postural tachycardia or their blood pressure dropping or so forth. So we have the tools. We don't need fancy autonomic labs. We don't even need a tilt table test. The diagnostic criteria for POTS is that you need to have either a 10-minute stand test or a tilt table test to get the diagnosis for POTS, orthostatic hypotension or even neurocardiogenic syncope. Now I think it's important to stress that even if a patient doesn't qualify, and let's say many patients with Long Covid will not elevate their heart rate by at least 30 beats per minute, it could be 20, it could be 25. These criteria are of course essential when we do research studies. But I think practically speaking, in patient care where everything is gray and nothing is black or white, especially in autonomic disorders, you really have to make a diagnosis saying, this sounds like autonomic dysfunction. Let me treat the patient for this problem.Eric Topol (11:07):Well, you brought up something that's really important because doctors don't have much time and they're inpatient. They don't wait 10 minutes to do a test to check your blood pressure. They send the patients for a tilt table, which nobody likes to have that test done, and it's unnecessary added appointment and expense and whatnot. So that's a good tip right there that you can get the same information just by checking the blood pressure and heart rate on standing for an extended period of time, which 10 minutes is a long time in the clinic of course. Now, what is the mechanism, what do you think is going on with the SARS-CoV-2 virus and its predilection to affect the autonomic nervous system? As you know, so many studies have questioned whether you even actually infect neurons or alternatively, which is more likely this an inflammation of the neural tissue. But what do you think is going on here?UnderpinningsSvetlana Blitshteyn (12:10):Right, so I think it's important to say we don't have exact pathophysiology of what exactly is going on. I think we can only extrapolate that what's going on in Long Covid is possibly what's going on in any post infectious onset dysautonomia. And so there are many hypothesis and there are many suggestions, and we share this disorder with cardiologist and immunologist and rheumatologist. The way I view this is what I described in my paper from a few years ago is that this is likely a central nervous system disorder with multisystemic involvement and it involves the cardiovascular system, immunologic, metabolic, possibly prothrombotic. The pathophysiology of all POTS closely parallels to pathophysiology of Long Covid. Now we don't know if it's the same thing and certainly I see that there may be more complications in Long Covid patients in the realm of cardiovascular manifestations in the realm of blood clots and things like that.Svetlana Blitshteyn (13:21):So we can't say it's the same, but it very closely resembles and I think at the core is going to be inflammation, autoimmunity and immunologic dysfunction. Now there are also other things that are very important and that would be mitochondrial dysfunction, that would be hypercoagulable state, it would be endothelial dysfunction. And I think the silver lining of Long Covid and having so many people invested in research and so many funds is that by uncovering what Long Covid is, we're now going to be uncovering what POTS and other autonomic disorders are. And I think we also need to mention a couple of other things. One is small fiber neuropathy, small fiber neuropathy and POTS are very much comorbid conditions. And similarly, small fiber neuropathy frequently occurs in patients with Long Covid, so that's a substrate with the damaged small nerve fibers that they're everywhere in our bodies and also innervate the organs as well.Svetlana Blitshteyn (14:34):The second big thing is that needs to be mentioned is hyperactive mast cells. So mast cells, small nerve fibers and capillaries are very much located in proximity. And what I have usually is a slide from an old paper in oral biology that gives you a specimen where you see a capillary vessel, a stain small nerve fiber, and in between them there is a mass cell with tryptase in it stained in black. And so there is a close communication between small nerve fibers between endothelial wall and between mast cells, and that's what we commonly see as a triad. We see this as a triad in Long Covid patients. We see that as a triad in patients with joint hypermobility syndrome and hypermobile EDS, and you also see this in many of the autoimmune disorders where people develop new allergies and new sensitivities concurrent or preceding the onset of autoimmune disease.Small Fiber NeuropathyEric Topol (15:49):Yeah, no, it's fascinating. And I know you've worked with this in Ehlers-Danlos syndrome (EDS) as you mentioned, the hypermobility, but just to go back on this, when you want to entertain the involvement of small fiber neuropathy, is that diagnosable? I mean it's obvious that you can get the tachycardia, the change in position blood pressure, but do you have to do other tests to say there is indeed a small fiber neuropathy or is that a clinical diagnosis?Svetlana Blitshteyn (16:20):Absolutely. We have the testing and the testing is skin biopsy. That is simply a punch biopsy that you can do in your clinic and it takes about 15 minutes. You have the free kit that the company of, there are many companies, I don't want to name specific ones, but there are several companies that do this kind of work. You send the biopsy back to them, they look under the microscope, they stain it. You can also stain it with amyloid stain to rule out amyloidosis, which we do in neurology, and I think that's quite accessible to many clinicians everywhere. Now we also have another test called QSART (quantitative sudomotor axon reflex test), and that's a test part of autonomic lab. Mayo Clinic has it, Cleveland Clinic has it, other big labs have it, and it's hard to get there because the wait time is big.Svetlana Blitshteyn (17:15):Patients need to travel. Insurance doesn't always authorize, so access is a big problem, but more accessible is the skin biopsy. And so, by doing skin biopsy and then correlating with neurologic exam findings, which oftentimes involved reduce pain and temperature sensation in the feet, sometimes in the hands you can conclude that the patient has small fiber neuropathy and that's a very tangible and objective diagnosis. There again, with everything related to diagnostics, some neuropathy is very patchy and the patchy neuropathy is the one that may not be in your feet where you do the skin biopsy. It may be in the torso, it may be in the face, and we don't have biopsy there. So you can totally miss it. The results can come back as normal, but you can have patchy type of small fiber neuropathy and there are also diagnostic tests that might be not sensitive to pick up issues. So I think in everything Long Covid, it highlights the fact that many tests that we use in medicine are outdated perhaps and not targeted towards these patients with Long Covid. Therefore we say, well, we did the workup, everything looks good. MRI looks good, cardiac echo looks great, and yet the patient is very sick with all kinds of Long Covid complications.Pure Post-Viral POTS?Eric Topol (18:55):Right. Now, before we get into the treatments, I want to just segment this a bit. Can you get pure POTS that is no Long Covid just POTS, or as you implied that usually there's some coalescence of symptoms with the usual Long Covid symptoms and POTS added to that?Svetlana Blitshteyn (19:21):So the studies have shown for us that about 40% of patients with POTS have post-infectious onset, which means more than a half doesn't. And so of course you can have POTS from other causes and the most common is puberty, hormonal change, the most common age of onset is about 13, 14 years old and 80% of women of childbearing age and other triggers or pregnancy, hormonal change again, surgery, trauma like concussion, post-concussion, autonomic dysfunction is quite common.Eric Topol (20:05):So these are pure POTS without the other symptoms. Is that what you're saying in these examples?Svetlana Blitshteyn (20:12):Well, it's a very good question. It depends what you mean by pure POTS, and I have seen especially cardiologists cling to this notion that there is pure POTS and then there is POTS plus. Now I think majority of people don't have pure POTS and by pure POTS I think you mean those who have postural tachycardia and nothing else. And so most patients, I think 80% have a number of symptoms. So in my clinic I almost never see someone who is otherwise well and all they have is postural tachycardia and then they're having a great time. Some patients do exist like that, they tend to be athletic, they can still function in their life, but majority of patients come to us with symptoms like dizziness, like fatigue, like exercise intolerance, decline in functioning. So I think there is this notion that while there is pure POTS, let me just fix the postural tachycardia and the patient will be great and we all want that. Certainly sometimes I get lucky and when I give the patient a beta blocker or ivabradine or a calcium channel blocker, sometimes we use it, certainly they get better, but most patients don't have that because the disability that drives POTS isn't actually postural tachycardia, it's all that other stuff and a lot of it's neurologic, which is why I put this as a central nervous system disorder.TreatmentsEric Topol (21:58):Yeah, that's so important. Now you mentioned the treatments. These are drug treatments, largely beta blockers, and can you tell us what's the success rate with the various treatments that you use in your clinic?Svetlana Blitshteyn (22:13):So the first thing we'll have to mention is that there are no FDA approved therapies for POTS, just like there are no FDA approved therapies for Long Covid. And so, everything we use is off label. Now, oftentimes people think that because it wasn't evidence-based and there are no big trials. We do have trials, we do have trials for beta blockers and we know they work. We have trials for Midodrine and we know that's working. We also have fludrocortisone, which is a medication that improves sodium and water resorption. So we know that there are certain things we've used for decades that have been working, and I think that's what I was trying to convey in this paper of post Covid autonomic dysfunction assessment and treatment is that when you see these patients, and you can be of any specialty, you can be in primary care, you can be a physiatrist, a cardiologist, there are things to do, there are medications to use.Svetlana Blitshteyn (23:20):Oftentimes colleagues would say, well, you diagnose them and then what do you treat them with? And then I can refer them to table six in that paper and say, look at this list. You have a lot of options to try. We have the first line treatment options, which are your beta blockers and Midodrine and Florinef and Mestinon. And then we have the second line therapies you can choose from the stimulants are there Provigil, Nuvigil, Wellbutrin, Droxidopa is FDA approved for neurogenic orthostatic hypotension. Now we don't use it commonly, but it can still be tried in people whose blood pressures are falling on your exam. So we have a number of medications to choose from in addition to non-pharmacologic therapies.Eric Topol (24:14):Right now, I'm going to get to the non-pharmacologic in a moment, but the beta blocker, which is kind of the first one to give, it's a little bit paradoxical. It makes people tired, and these people already are, don't have much energy. Is the success rate of beta blocker good enough that that should be the first thing to try?Svetlana Blitshteyn (24:35):Absolutely. The first line medication treatment options are beta blockers. Why? Okay, why are they working? They're not only working to reduce heart rate, but they may also decrease sympathetic overactivity, which is the driving mechanism of autonomic dysfunction. And when you reduce that overactivity, even your energy level can improve. Now, the key here is to use a low dose. A lot of the time I see this mistake being done where the doctor is just prescribing 25 milligrams of metoprolol twice a day. Well, this is too high. And so, the key is to use very low doses and to use them and then increase them as needed. We have a bunch of beta blockers to choose from. We have the non-selective propranolol that you can use when someone maybe has a migraine headache or significant anxiety, they penetrate the brain, and we have non-selected beta blockers like atenolol, metoprolol and others that you can use at half a tablet. Sometimes I start my patients at quarter of tablet and then go from there. So low doses will block tachycardia, decrease sympathetic overactivity, and in many cases will allow the patient to remain upright for longer periods of time.Eric Topol (26:09):That's really helpful. Now, one of the other things, I believe it's approved in Canada, not in the US, is a vagal neuromodulation device. And I wonder, it seems like it would be nice to avoid drugs if there was a device that worked really well. Is there anything that is in the hopper for that?Svetlana Blitshteyn (26:32):Yeah, absolutely. Non-invasive vagus nerve stimulator is in clinical trials for POTS and other autonomic disorders, but we have it FDA for treatment of migraine and cluster headaches, so it's already approved here and it can also be helpful for chronic pain and gastroparesis. So there are studies on mice that show that with the application of noninvasive vagus nerve stimulator, there is reduction of pro-inflammatory cytokines. So here is this very important connection that comes from Kevin Tracey's work that showed inflammatory reflex, and that's a reflex between the vagus nerve and the immune system. So when we talk about sympathetic overactivity, we need to also think about that. That's a mechanism for pro-inflammatory state and possibly prothrombotic state. So anything that decreases sympathetic overactivity and enhancing parasympathetic tone is going to be good for you.Eric Topol (27:51):Now, let's go over to, I mean, I'm going to get into this body brain axis in a moment because there's another part of the story here that's becoming more interesting, fascinating, in fact every day. But before I do that, you mentioned the small fiber neuropathy. Is there a specific treatment for that or is that just something that is just an added dimension of the problem without a specific treatment available?Svetlana Blitshteyn (28:21):Yeah, we certainly have treatment for small fiber neuropathy. We have symptomatic treatment for neuropathic pain, and these medications are gabapentin, pregabalin, amitriptyline and low dose naltrexone that have been gaining popularity. We used that before the pandemic. We used low dose naltrexone for people with chronic pain related to joint hypermobility. And so, we have symptomatic, we also have patches and creams and all kinds of topical applications for people with neuropathic pain. Then we also have, we try to go for the root cause, right? So the number one cause of small fiber neuropathy in the United States is diabetes. And certainly, you need to control hyperglycemia and in some patients you only need a pre-diabetic state, not even full diabetes to already have peripheral neuropathy. So you want to control blood glucose level first and foremost. Now then we have a big category of autoimmune and immune mediated causes, and that's where it gets very interesting because practical experience from many institutions and many neurologists worldwide have shown that when you give a subset of patients with autoimmune small fiber neuropathy, immunotherapy like IVIG, a lot of patients feel significantly better. And so, I think paralleling our field in dysautonomia and POTS, we are looking forward to immunotherapy being more mainstream rather than exception from the rule because access and insurance coverage is a huge barrier for clinicians and patients, but that may be a very effective treatment options for treatment refractory patients whose symptoms do not improve with symptomatic treatment.Eric Topol (30:38):Now, with all these treatments that are on the potential menu to try, and of course sometimes it really is a trial and error to get one that hopefully works for Covid, Long Covid, what is the natural history? Does this persist over years, or can it be completely resolved?Svetlana Blitshteyn (31:00):That's a great question. Everyday Long Covid patients ask me, and I think what we are seeing is that there is a good subset of patients for whom Long Covid is going to be temporary and they will improve and even recover close to normal. Now remember that original case series of patients that I reported in early 2021 based on my 2020 experience in that 20 patient case series, very few recovered, three patients recovered back to normal. Most patients had lingering ongoing chronic symptoms. So of course mine is a kind of a referral bias where I get to see the sickest patients and it looks to be like it's a problem of chronic illness variety. But I also think there is going to be a subset of patients and then we have to study them. We need to study who got better and who didn't. And people improve significantly and some even recover close to normal. But I think certain symptoms like maybe fatigue and heat intolerance could persist because those are very heavily rooted in autonomic dysfunction.Vaccination and POTSEric Topol (32:26):Yeah, well, that's something that's sobering and why we need trials and to go after this in much more intensity and priority. Now the other issue here is while with Covid, this is almost always the virus infection, there have been reports of the vaccine inducing POTS and Long Covid, and so what does that tell us?Svetlana Blitshteyn (32:54):Well, that's a big, big topic. Years ago, I was the first one to report a patient with POTS that was developed after HPV vaccine Gardasil. Now, at that time I was a young neurologist. Then the patient came to me saying she was an athlete saying two weeks after Gardasil vaccine, she developed these very disabling symptoms. And I thought it was very interesting and unique and I thought, well, I'll just publish it. I never knew that this would be the start of a whole different discussion and debate on HPV vaccines. There were multiple reports from numerous countries, Denmark, Mexico, Japan. Japan actually suspended their mass HPV vaccination program. So somehow it became a big deal. Now many people, including my colleagues didn't agree that POTS can begin POTS, small fiber neuropathy, other adverse neurologic events can begin after vaccination in general. And so, this was a topic that was widely debated and the European medical agencies came back saying, we don't have enough evidence.Svetlana Blitshteyn (34:20):Of course, we all want to have a good cancer vaccine. And it was amazing to watch this Covid vaccine issue unfolding where more than one study now have shown that indeed you can develop POTS after Covid vaccines and that the rate of POTS after Covid vaccines is actually slightly higher than before vaccination. So I think it was kind of interesting to see this unfold where I was now invited by Nature Journal to write an editorial on this very topic. So I think it's important to mention that sometimes POTS can begin after vaccination and however, I've always advised my patients to be vaccinated even now. Even now, I have patients who are unvaccinated and I say, I'm worried about you getting a second Covid or third without these vaccines, so please get vaccinated. Vaccines are very important public health measure, but we also have to acknowledge that sometimes people develop POTS, small fiber neuropathy and other complications after Covid vaccines.Prominence of the Vagus Nerve Eric Topol (35:44):Yeah, I think this is important to emphasize here because of all vaccinations can lead to neurologic sequelae. I mean look at Guillain-Barre, which is even more worrisome and that brings in the autoimmune component I think. And of course, the Covid vaccines and boosters have a liability in a small, very small percentage of people to do this. And that can't be discounted because it's a small risk and it's always this kind of risk benefit story when you're getting vaccinated that you are again spotlighting. Now gets us to the biggest thing of all besides the practical pearls you've been coming up with to help everyone in patients and clinicians. In recent weeks, there's been explosion of these intra body circuits. There was a paper from Columbia last week that taught us about the body-brain circuits between the vagus nerve and the caudal Nucleus of the Solitary Tract (cNST) of the brain and how this is basically a master switch for the immune system. And so, the vagus nerve there and then you have this gut to brain story, which is the whole gut microbiome is talking to the brain through the vagus nerve. I mean, everything comes down to the vagus nerve. So you've been working all your career and now everything's coming into this vagus nerve kind of final common pathway that's connecting all sorts of parts of the body that we didn't truly understand before. So could you comment about this because it's pretty striking.Svetlana Blitshteyn (37:34):Absolutely. I think this pandemic is highlighting the pitfalls of everything we didn't know but should have in the past. And I think this is one of them. How important is the autonomic nervous system and how important is the vagus nerve that is the longest nerve in the body and carries the parasympathetic outflow. And I think this is a very important point that we have to move forward. We cannot stop at the autonomic knowledge that we've gained thus far. Autonomic neurology and autonomic medicine has always been the field with fellowship, and we have American Autonomic Society as well. But I think now is a great time to move forward and study how the autonomic nervous system communicates with the immunologic system. And again, Kevin Tracey's work was groundbreaking in the sense that he connected the dots and realized that if you stimulate the vagus nerve and the parasympathetic outflow, then you can reduce pro-inflammatory cytokines and that he has shown that you can also improve or significantly such disorders like rheumatoid arthritis and other autoimmune inflammatory conditions.Svetlana Blitshteyn (39:03):Now we have the invasive vagus nerve stimulation procedures, and quite honestly, we don't want that to be the mainstream because you don't want to have a neurosurgery as you go to treatment. Of course, you want the non-invasive vagus nerve stimulation being the mainstream therapy. But I think a lot of research needs to happen and it's going to be a very much a multidisciplinary field where we'll have immunology, translational sciences, we'll have neurosurgeons like Kevin Tracey, we'll have rheumatologists, neurologists, cardiologists. We'll have a multidisciplinary collaborative group to further understand what's going on in these autoimmune inflammatory disorders, including those of post-infectious origin.Eric Topol (40:02):I certainly agree with all of your points there. I mean, I'm really struck now because the immune system is front and center with so much of what we're seeing with of course Long Covid, but also things like Alzheimer's and Parkinson's and across the board with metabolic diseases. And here we have this connection with your sweet spot of the autonomic nervous system, and we have these pathways that had not been delineated before. I didn't know too much about the cNST of the brain to be such an important connect point for this. And I wonder, so here's another example. Concurrently the glucagon-like peptide 1 (GLP-1) drugs have this pronounced effect on reducing inflammation in the body before the weight loss and in the brain through the gut-brain axis, as we recently discussed with Dan Drucker, have you ever tried a GLP-1 drug or noticed that GLP-1 drugs help people with Long Covid or the POTS problem?Svetlana Blitshteyn (41:12):So I have heard anecdotally people with Long Covid using these drugs for other reasons, saying I feel much better. In fact, I recently had a woman who said, I have never been more productive than I am now on this medication. And she used the word productive, which is important because non-productive implies so many things. It's the brain fog, it's the physical fatigue, it's the mental fatigue. So I think we are, first of all, I want to say, I always said that the brain is not separate from the body. And neurologic manifestations of systemic disease is a very big untapped area. And I think it's not going to be surprising for me to see that these drugs can improve many brain parameters and possibly even neuroinflammation. We don't know, but we certainly need to study this.Eric Topol (42:15):Yeah, it's interesting because statins had been tried for multiple sclerosis, I think maybe not with very clear cut benefit effects, but here you have a new class of drugs which eventually are going to be in pills and not just one receptor but triple receptor, much more potent than what we're seeing in the clinic today. And you wonder if we're onto an anti-inflammatory for the brain and body that could help in this. I mean, we have a crisis here with Long Covid in POTS without a remedy, without adequate resources that are being dedicated to the clinical trials that are so vital to execute and find treatments. And that's just one candidate of many. I mean, obviously there's so many possible ones on the list. So if you could design studies now based on your extraordinary rich experience with Long Covid and POTS, what would you go after right now? What do you think is the thing that's, would it be to evaluate more of these noninvasive, non-pharmacologic treatments like the vagal nerve stimulation, or are there particular drugs that you find intriguing?Svetlana Blitshteyn (43:33):Well, a few years ago we published a case series of patients with severe POTS and nothing helped them, but they improved significantly and some even made close to recovery improvement and were able to return to their careers because they were treated with immunotherapy. So the paper is a subcutaneous immunoglobulin and plasmapheresis and the improvement was remarkable. I say there was one physician there who could not start her residency. She got sick in medical school and could not start her residency due to severe POTS and no amount of beta blockers, Midodrine or Florinef helped her get out the house and out of bed. And therefore, sheer luck, she was able to get subcutaneous immunoglobulin and she improved significantly, finished her residency and is now a practicing physician. So I think when we have these cases, it's important to bring them to scientific community. And I think I'm very excited that hopefully soon we're going to have trials of immunotherapy and immunomodulating treatment options for patients with Long Covid and hopefully POTS in general, I believe in novel, but also repurposed, repurposed treatment.Svetlana Blitshteyn (45:01):IVIG has been used for decades, so it's not a new medication. And contrary to popular belief, it's actually quite safe. It is expensive, it's a blood product, but we are very familiar with it in medicine and neurology. So I think we have to look forward to everything. And as I tell my patients, I'm always aggressive with medications when they come to me and their doctor said something like, well, let's see, it's going to go away on its own or keep doing your salt and fluids intake or wear compression sucks. Well, they're already doing it. It's not helping. And now it's a good time to try everything we have. And I would like to have more. I would like to have immunotherapy available. I would like to have immunosuppressants even tried potentially, and maybe we'll be able to try medication for possible viral persistence. Let's see how that works out. We have other inflammatory modalities out there that can potentially give us the tools. You see, I think being that it's a multifactorial disorder, that I don't think it's going to be one thing for everyone. We need to have a toolbox where we're going to choose what's best for your specific case because when we talk about Long Covid, we have to remember there are many different phenotypes under that umbrella.A Serious MatterEric Topol (46:40):Now, before we wrap up, I mean I guess I wanted to emphasize how there are clinicians out there who discount Long Covid in POTS. They think it's something that is a figment of imagination. Now, on the other hand, you and I especially, you know that people are totally disabled. Certain days they can't even get out of bed, they can't get back to their work, their life. And this can go on and on as we've been discussing. So can you set it straight about, I mean, you are seeing these people every day. What do you have to say to our fellow colleague physicians who tend to minimize and say, this is extremely rare, if it even exists, and that these people have some type of psychiatric problem. And it's really, it's distressing of course, but could you speak to that?Svetlana Blitshteyn (47:39):Absolutely. So as I always say, Long Covid is not a psychiatric or psychological disorder, and it's also not a functional neurologic disorder. Now, having said that, as I just mentioned, brain is not separate from the body. And neurologic manifestations of systemic disease are numerous. We just had a paper out on neurologic manifestations of mast cell activation syndrome. So certainly some patients will develop psychiatric manifestations and some patients will develop major depression, anxiety, OCD or functional neurologic disorder. But those are complications of systemic disease, meaning that you cannot diagnose a patient with anxiety and send them off to a psychologist or a psychiatrist without diagnosing POTS and treating it. And in many cases, when you approach an underlying systemic disorder with the right medications, like dysautonomia for example, all of the symptoms including psychological and psychiatric, tend to improve as well. And certainly, there is going to be a small subset of Long Covid patients whose primary problem is psychiatric.Svetlana Blitshteyn (49:01):And I think that's totally fine. That is not to say that all Long Covid is psychiatric. Some will have significant psychiatric manifestations. I mean, there are cases of post Covid psychosis and autoimmune encephalitis and all kinds of psychiatric problems that people may develop, but I think we can't really stratify well, this is physiologic and this word functional that I'm not a fan of. This is physiologic as we see it on MRI. But here, because we don't see anything on MRI, it means you are fine and can just exercise your way out of it. So I think with this Long Covid, hopefully we'll get answers as to the pathophysiology, but also most importantly, hopefully we'll get these therapies that millions of people before Covid pandemic were looking for.Eric Topol (50:02):Well, I just want to thank you because you were onto this well over 10, 15 years before there was such a thing as Covid, you've dedicated your career to this. These are some of the most challenging patients to try to help and has to be vexing, that you can't get their symptoms resolved no less the underlying problem. And we're indebted to you, Svetlana, because you've really been ahead of the curve here. You were writing a patient book before there were such things as patient activists in Long Covid, as we've seen, which have been so many of the heroes of this whole problem. But thank you for all the work you do. We'll continue to follow. We learned from you about POTS and Long Covid from your work and really appreciate everything you've done. Thank you.Svetlana Blitshteyn (50:58):Thank you so much, Eric, for having me. As I said, it's a great honor for me to be here. Remarkable, amazing. And thank you for all this work that you're doing and being an advocate for our field because we always need great champions to help us move forward in these complicated disorders.********************************The Ground Truths newsletters and podcasts are all free, open-access, without ads.Voluntary paid subscriptions all go to support Scripps Research. Many thanks for that—they greatly helped fund our summer internship programs for 2023 and 2024.Thanks to my producer Jessica Nguyen and Sinjun Balabanoff tor audio and video support at Scripps ResearchNote: you can select preferences to receive emails about newsletters, podcasts, or all I don't want to bother you with an email for content that you're not interested in. Get full access to Ground Truths at erictopol.substack.com/subscribe
Navigating the intricate landscape of mental health can often feel like deciphering a complex puzzle, especially when differentiating between conditions ADHD vs.anxiety. This challenge is further compounded by the similarities in symptoms and the potential for misdiagnosis. However, understanding the nuances and interconnections between these conditions can empower individuals to seek appropriate treatment and improve their quality of life. ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity. While commonly diagnosed in childhood, ADHD persists into adulthood for many individuals, affecting various aspects of their daily lives, from academic performance to personal relationships. On the other hand, anxiety disorders encompass a range of conditions marked by excessive fear, worry, and physical symptoms such as heart palpitations and dizziness. The intersection of ADHD and anxiety is a topic of significant interest within the mental health community. Individuals with ADHD often experience anxiety, partly due to the challenges and frustrations stemming from ADHD symptoms. Similarly, the constant struggle with focus and organization can exacerbate feelings of anxiety, creating a cyclical relationship between the two conditions. A critical aspect of differentiating ADHD from anxiety involves examining the onset and progression of symptoms. ADHD is present from an early age, with symptoms often becoming noticeable during childhood. In contrast, anxiety can develop at any point in life, triggered by stressors or traumatic events. Therefore, a thorough evaluation of an individual's history is vital in distinguishing between the two. Moreover, the manifestation of symptoms can offer clues. For example, while both ADHD and anxiety can lead to concentration difficulties, the underlying reasons differ. In ADHD, the inability to focus is often due to intrinsic attention regulation issues. In anxiety, however, the concentration problems may arise from excessive worry or fear that consumes cognitive resources. Understanding the unique and overlapping aspects of ADHD and anxiety is crucial for effective treatment. For ADHD, interventions typically include medication, such as stimulants, alongside behavioral strategies to enhance executive functioning skills. Anxiety disorders, meanwhile, may be treated with a combination of psychotherapy, such as cognitive-behavioral therapy (CBT), and, in some cases, medication to manage symptoms. The integration of treatment modalities is paramount, particularly for individuals experiencing both ADHD and anxiety. Addressing the ADHD symptoms can often alleviate anxiety by improving self-esteem and coping mechanisms. Similarly, managing anxiety can reduce the overall stress load, making ADHD symptoms more manageable. In conclusion, ADHD and anxiety represent two distinct yet interrelated conditions within the spectrum of mental health. The complexity of their relationship underscores the importance of personalized, comprehensive treatment plans. By fostering a deeper understanding of these conditions, individuals can navigate the path to wellness with greater clarity and confidence. This journey, though challenging, is a testament to the resilience and strength inherent in the human spirit, as we seek to understand and overcome the obstacles that lie within our minds. TRANSCRIPT Kimberley: Welcome, everybody. We are talking about ADHD vs anxiety, how to tell the difference, kind of get you in the know of what is what. Today, we have Dr. Ryan Sultan. He is an Assistant Professor of Clinical Psychiatry at Columbia University. He knows all the things about ADHD and cannabis use, does a lot of research in this area, and I want to get the tea on all things ADHD and anxiety so that we can work it out. So many of you listening have either been misdiagnosed or totally feel like they don't really understand the difference. And so, let's talk about it. Welcome, Dr. Sultan. ADHD vs. ANXIETY Ryan: Thank you. I really like doing these things. I think it's fun. I think psychiatrists, which is what I am, I think one of the ways that we really fail, and medical doctors in general don't do well at this, which is like, let's spend some time educating the public. And before my current position, I did epidemiology and public health. And so, I learned a lot about that, and I was like, “You know how you can help people? We have a crisis here. Let's just teach people things about how to find resources and what they can do on their own.” And so, I really enjoy these opportunities. WHAT IS ADHD vs. WHAT IS ANXIETY? I was thinking about your question, and I was thinking how we might want to talk about this idea of ADHD versus anxiety, which is a common thing. People come in, and they see me very commonly wanting an evaluation, and they think they have ADHD. And I understand why they think they have ADHD, but their main thing is basically reporting a concentration or focus issue, which is a not specific symptom. Just like if I'm moody today, that doesn't mean I have a mood disorder. If I'm anxious today, it doesn't mean I have an anxiety disorder. I might even feel depressed today; it doesn't mean I have a depression disorder. I could even have a psychotic symptom in your voice, and it does not mean that I have a psychotic disorder. It's more complicated than that. I think one of the things that the DSM that we love here in the United States—but it's the best thing we have; it's like capitalism and democracy; it's like the best things that we have; we don't have better solutions yet—is that it describes these things in a way that uses plain language to try to standardize it. But it's confusing to the general public and I think it's also confusing to clinicians when you're trying to learn some of these conditions. WHEN IS ADHD vs. ANXIETY DIAGNOSED? And certainly, one of the things that have happened in my field that people used to talk a lot about is the idea that, is pediatric, meaning kid diagnosis of ADHD, which often in my area here in the United States will be done by pediatrician, are they adequately able to do that? Because poor pediatricians have to know a lot. And ADHD, psychiatric disorders are complicated. Mental health conditions are super complicated. They're so complicated that there are seven different types of degree programs that end up helping you with them. PsyD, PhD, MD, clinical social worker, mental health counselor, and then there's nurse practitioner. So, like super complicated counseling. So, how do we think about this? The first thing I try to remind everyone is, if you're not sure what's going on with you, please filter your self-diagnosis. You can think about it, that's great. Write your notes down, da-da-da, but I would avoid acting purely on that. You really want to do your best to get some help from the outside. And I know that mental health treatment is not accessible to everyone. This is an enormous problem that existed before the pandemic and still exists now. I say that because I say that all the time, and I wish I had a solution for you. But if you have access to someone that you think can help you tease this throughout, you want to do that. SYMPTOMS OF ADHD vs. ANXIETY But what I would like us to do, instead of listing criteria, which you can all Google on WebMD, let's think about them in a larger context. So, mental health symptoms fall into these very broad categories. And so, some of them are anxiety, which OCD used to be under, but it's now in its own area. Another one, would be mood. You can have moods that are really high, moods that are really low. Another one you could take ADHD, you could lump it in neurodevelopmental, which would mix it with autism and learning disorders. You could lump it with attention, but the problem with that is it would also get lumped with dementia, which are processes that overlap, but they're occurring at different ends of the spectrum. So, let's think about ADHD and why someone might have ADHD or why you might think someone has ADHD, because this should be easier for people to tease out, I think. ADHD is not a condition that appears in adulthood. That's like hands down. Adult ADHD is people that had ADHD and still have ADHD as adults. And most people with ADHD will go on to still have at least an attenuated version, meaning their symptoms are a little less severe, maybe, but over 60% will still meet criteria. It's not a disorder of children. Up until the ‘90s, we thought it was a disorder of kids only. So, you turned 18, and magically, you couldn't have ADHD anymore, which didn't make any sense anyway. So, to really get a good ADHD diagnosis, you got to go backwards. If you're not currently an eight-year-old, you have to think a little bit about or talk to your family, or look at your school records. And ideally, that's what you want to do, is you want to see, is there evidence that you have, things that look like ADHD then? So, you were having trouble maintaining your attention for periods of time. Your attention was scattered in different ways. Things that are mentally challenging that require you to force yourself to do it, that particularly if you don't like them, this was really hard for you. You were disorganized. People thought that things went in one year and out the other. Now this exists on a spectrum. And depending on the difficulty of your scholastic experience and how far you pushed yourself in school, these symptoms could show up at different times. For example, it's not uncommon for people to show up in college or in graduate school. Less so now, but historically, people were getting diagnosed as late as that, because now they have to write a dissertation. For those of you guys who don't know, a dissertation is being asked to write a book, okay? You're being asked to write a book. And what did you do? You went to college. Okay, you went to college, and then you had some master's classes, and then you get assigned an advisor, and you just get told to figure out what your project is. It is completely unstructured. It is completely self-sufficient. It is absurd. I'm talking about a real academic classic PhD. That is going to bring it. If somebody has ADHD, that's going to bring it out because of the executive functioning involved in that, the organization, the planning. I got to make an outline, I got to meet with my mentor regularly, I got to check in with them, I got to revise it, I got to plan a study or a literature review. There's so many steps involved. So, that would be something that some people doesn't come up with then. Other kids, as an eight-year-old boy that I'm treating right now, who has a wonderful family that is super supportive, and they have created this beautiful environment for him that accommodates him so much that he has not needed any medication despite the fact that there's lots of evidence that he is struggling and now starting to feel bad about himself, and he has self-esteem issues because he just doesn't understand why he has to try so hard and why he can't maintain his attention in this scenario, which is challenging for him. So, ADHD kids and adults, you want to think of them as their brains as being three to five years behind everyone else in their development, okay? And they are catching up, but they're more immature, and they're immature in certain ways. And so, this kid's ability to maintain his attention, manage his own behaviors, stay organized, it's like mom is sitting with this kid doing his homework with him continuously, and if she stops at all, he can't hold it together on his own. So, when we think about that with him, like, okay, well, that's maybe when it's showing up with him. That's when it's starting to have a struggle with him. But let's relate it to anxiety. One problem would be, do you have ADHD or do you have anxiety? Well, there's another problem. Another problem is having ADHD is a major risk factor for developing an anxiety disorder, okay? So now I'm the eight-year-old boy, and this eight-year-old boy does not have the financial resources to get this evaluation, or the parents that are knowledgeable enough to know that, it might even have been years ago where there was less knowledge about this. And he's just struggling all the time, and he feels bad about himself, and he's constantly getting into trouble because he is losing things because he can't keep track of things because he's overwhelmed. And now he feels bad about himself. Okay. He has anxiety associated with that. So now we're building this anxiety. So he might even get mood symptoms, and now we have a risk for depression. So, this is just one of the reasons why these things are like these tangled messes. You ever like have a bunch of cords that you have one of the dealies, you keep throwing them in a box, and now you're like, “What do I do? Do I just throw the cords out or entangle them?” It's a very tangled mess. Of course, it takes time to sort through it. The reason I started with ADHD is that it has a clear trajectory of it when it happens. And in general, it's a general rule, symptomatology, meaning like how severe it is and the number of symptoms you have and how impairing it is. They're going to be decreasing as you get older. At least until main adulthood, there's new evidence that shows there might be a higher risk for dementia in that population. But let's put geriatric aside. There's a different developmental trajectory. Whereas anxiety, oh God, I wish I could simplify anxiety that much. Anxiety can happen in different ways. So, let's start with the easy thing. Why would you confuse them in this current moment? If I am always worried about things, if I'm always ruminating about things, I'm thinking about it over and over again, I'm trying to figure out where I should live or what I should do about this, and I just keep thinking about it over and over again, and I'm in like a cycle. Like, pop-pa-pa pop-pa pop-pa-pa-pa. And then you're asking me to do other things. I promise you, I will have difficulty concentrating. I promise you, I can't concentrate because it's like you're using your computer and how many windows do you have open? How many things are you running? I mean, it doesn't happen as much anymore, but I think most of us, I meant to remember times where you're like, “Oh, my computer is not able to handle this anymore.” You're using up some of your mind, and you can call that being present. So, when people talk about mindfulness and improving attention, one of the things that they're probably improving is this: they're trying to get the person to stop running that 15, 20% program all the time. And it's like your brain got upgraded because you can now devote yourself to the task in front of you. And the anxiety is not slowing you down or intruding upon you, either as an intrusive thought in an OCD way or just a sort of intrusive worry that's probably hampering your ability to do something concentration-intensive. And then if you have anxiety problems and you're not sleeping right, well, now your memory is impaired because of that. So, there's this cycle that ends up happening over and over again. IS HYPERACTIVITY ANXIETY OR ADHD? Kimberley: Yeah, I think a lot of people as well that I've talked to clients and listeners, also with anxiety, there's this general physiological irritability. Like a little jitteriness, can't sit in their chair, which I think is another maybe way that misdiagnosis can -- it's like, “Oh, they're hyperactive. They're struggling to sit in their chair. That might be what's going on for them.” Is that similar to what you're saying? Ryan: Yeah. So, really good example, and this one we can do a little simpler. I mean, the statement I'm going to say is not 100% true, but it's mostly true. If you are an adult, like over 25 for sure, and you are physically jittery, it is very unlikely that that is ADHD. Because ADHD, the whole mechanism as we understand it, or one of the mechanisms causing the thing we call ADHD, which of course is like a made-up thing that we're using to classify it, is that your prefrontal cortex is not done developing. So, it needs to get myelinated, which is essentially like -- think about it like upgrading from dial up to some great, not even a cable modem. You're going right to Verizon Fios. Like amazing, okay. It's much faster, and it's growing. And that's the part of you that makes you most human. That's the most sophisticated part of your brain. It's not the part that helps you breathe or some sort of physiological thing, which, by the way, is causing some of those anxiety symptoms. They're ramped up in a sympathetic nervous system way, fight or fight way. It's the part that's actually slowing you down. That's like, “Whoa, whoa, whoa, whoa, whoa, calm down, calm down, calm down.” This is why, and everyone's is not as developed. So, we're all developing this thing through 25, at least ADHD is through 28. Car insurance goes down to 25 because your driving gets better, because your judgment gets better, because you can plan better, because you are less risk-taking. So, your insurance has now gone down. So, the insurance company knows this about us. And our FMRI scans, you scan people's brains, it supports that change. These correlate to some extent with symptomology, not enough to be a diagnosis to answer the person's question that they're going to have that. I wish it was. It's not a diagnosis. We haven't been able to figure out how to do that yet. So, by the time you're 25, that's developed. And the symptoms that go away first with ADHD are usually hyperactivity, because that's the inability to manage all the impulses of your body, not in an anxious, stressed-out way, but in an excited way. You think of the happy, well-supported, running around ADHD kid is kind of silly and fun. It's a totally different mood experience than the anxiety experience. Anxiety experience is unpleasant for the most part. Unless your anxiety is targeting you to hyper-focus to get something done, which is bumping up some of your dopamine, which is again the opposite experience of probably having ADHD, it's a hyper-focus experience, certainly, the deficit part of ADHD, you're going to be feeling a different physiological, the irritability you talked about 100%. You're irritable because you are trying so hard to manage this awful feeling you have in your body. You physically feel so uncomfortable. It is intolerable. I have this poor, anxious young man that has to do a very socially awkward thing today. Actually, not that socially awkward. He created the situation, which is one of the ways we're working on it with him in treatment. And I'm letting him go through and do this as an exposure because it'll be fine. And he's literally interacting with another one of our staff members. But he finds these things intolerable. He talks about it like we are lighting him on fire. So, he's trying to hold it together, or whatever your physiological experience is. It may not have been as dramatic as I described. You're irritable when people are asking things of you because you don't have much left. You're not in some carefree mood where you're like, “Whatever, I'm super easygoing. I don't care.” No, you're not feeling easygoing right now. You're very, very stressed out. Stress and anxiety are very linked. Just like sadness and depression are very linked, and like loneliness and depression are linked, but they're not the same thing. Stress and anxiety are very, very linked, and they're similar feelings, and they're often occurring at the same time and interacting with each other. ADD vs. ADHD Kimberley: Right. One question really quick. Just to be clear, what about ADD vs. ADHD? Ryan: We love to change diagnostic criteria. People sit around. There's a committee, there's a whole bunch of studies. And we're always trying to epidemiologically and characterologically differentiate what these different conditions are. That's what the field is trying to do as an academic whole. And so, there's disagreements about what should be where. So, the OCD thing moving is one of them. The ADD thing, it's like a nomenclature thing. So, the diagnosis got described that the new current version of the diagnosis is attention deficit hyperactivity disorder, and then you have three specifiers, okay? So, that's the condition you have. And then you can have combined, which is hyperactive and inattentive. Just inattentive, just hyperactive. And impulsive is built in there. So, it's really not that interesting. People love to be like, “No, no, I have ADD. No, I don't have the hyperactive.” And I'm like, “I know, but from a billing point of view, the insurance company will not accept that code anymore. It doesn't exist.” DOES ADHD OR ANXIETY IMPACT CONCENTRATION? Kimberley: Yeah. So, just so that I know I have this right, and you can please correct me, is if you have this more neurological, like you said, condition of ADHD, you'll have that first, and then you'll get maybe some anxiety and some depression as a result of that condition. Whereas for those folks, if their primary was anxiety, it wouldn't be so much that anxiety would cause the ADHD. It would be more the symptoms of concentration are a symptom of the anxiety. Is that what you're saying? Ryan: Yes, and every permutation that you can imagine based on what you just said is also an option. Like almost every permutation. Like how are they interacting with each other? How are they making each other worse? How are they confusing each other? Because you can have anxiety disorders in elementary school. I mean, that is when most anxiety disorders, the first win, like the wave of them going up is then. And you think about all the anxiety you have. I got a friend of mine who's got infants. And it's fun to see like as they're developing, when they go through normal anxiety, that that is a thing that they're going to pass. And then there's other things where, at some point, we're like, actually, now we're saying this is developmentally inappropriate, which means, nope, we were supposed to have graduated from this and it's still around. And so, one of the earlier ways that psychiatric conditions were conceptualized, and it's still a useful way to conceptualize them, is the normal behavior version of it versus the non-normal behavior version of it. And again, I hate non-normal, I don't want to pathologize people, but non-normal being like, this is causing problems for you. And if you think about it from an evolutionary point of view, all of these conditions have pretty clear evolutionary bases of how they would be beneficial. Anxiety is going to save your ass, okay? Properly applied anxiety, it'll save your tribe. You want someone who's anxious, who's going to be like, “We do not have enough from this winter.” An ADHD person was like, “It'll be fine. I'm just going to go find something else.” And you're like, “No.” And then when that winter's really bad and you save that little bit of extra food, that 30% that the anxious person pushed for, maybe you didn't eat all 30% of it, but you know what, it probably benefited you and it might've actually made the whole tribe survive or more people survive or better health condition. So, it's approving everyone's outcomes. The ADHD individual, you get them excited about something—gone. They're going to destroy it. They're going to find all the berries. They're going to find all the new places. They're going to find all the new deer. They're going to run around and explore. It's great. Great, great, great. Depression is like hibernation. And if you look at hibernation in a mammal, like what happens, there's a lot of overlaps. Lower energy, maybe you store up some food for the winter. It's related to the seasons. You're in California, right? This is not a problem you have, but for those of us in New York, where we have seasonality, seasonal depression is a thing. It's very much a thing. It's very noticeable, and it's packed on top of these conditions everyone else is having. But the idea is that the hibernation or the pullback is like something happens to you that upsets you, which is the psychosocial event that's kicking you in the face that might set off your depression. That's why people always say, “Oh, depressions just don't come out of nowhere. This biochemical thing isn't true.” What they're saying is something has to happen to start to kick off the depression, but that's not enough. It's that you then can't recover from it. And so, a normal version of it is that you get knocked out and you spend a week or two, you think about it. Rumination is a part of depression for many people. You reevaluate, and you say, “You know, I got kicked in the face when I did that. That was not a good plan for me. I need a new plan. I either need to do something different or I need to tackle that problem differently.” And so, that would be the adaptive version of a depressive experience. Whereas the non-adaptive version is like, you get stuck in that and you can't get out. Kimberley: Or you avoid. Ryan: The avoiding doing anything about it, and then that makes it worse. So, you started withdrawing. I mean, that's the worst thing you can do. This is a message to everyone out there. The worst thing that you can do is withdraw from society for any period of time. Look, I'm not saying you can't have a mental health day, but systematic withdrawal, which most of us don't even realize is happening, is going to make you worse because the best treatment for every mental health condition is community. It is really. All of them. All of them, including schizophrenia. I used to work in Atlanta. I did my residency. There'd be these poor guys that have a psychotic disorder. They hear voices. The kinds of people that, here in New York City, are homeless, they're not homeless there. Everyone just knows that Johnny's just a little weird and his mom lives down the street. And if we find Johnny just in the trash can or doing something strange, or just roving, we know he's fine, and someone just takes him back to his mom's house and checks on him. Because there's a community that takes care of him, even though he's actually quite ill from our point of view. But when you put him in an environment where that community is not as strong, like a city, it does worse, which is why mental health conditions are much higher rates in urban areas. Probably why psychiatry and mental health in general is such a central thing in New York City. TREATMENT FOR ADHD vs. ANXIETY Kimberley: Yeah. Okay, let's talk quickly about treatment for ADHD. We're here always talking about the treatment for anxiety, but what would the research and what's evidence-based for ADHD if someone were to get that clinical diagnosis? Ryan: So, you want to think about ADHD as a thing that we're going to try to frame for that person as much as how is it an asset, because it historically has made people feel bad about themselves. And so, there are positive aspects to it, like the hyper focus and excitability, and interest in things. And so, trying to channel into that and then thinking about what their deficits are. So, they're functional deficits. If you're talking adult population, functional deficits are going to be usually around executive functioning and organization planning. Imagine if you're like a parent of small children and you have untreated ADHD, you're going to be in crazy fight-or-flight mode all the time because there's so many things to keep track of. You have to keep track of your wife and their life. Kimberley: I see these moms. My heart goes out to them. Ryan: And they're probably anxious. And the anxiety is probably protecting them a little bit. Because what is the anxiety doing? You think about things over and over and over again, and you double check them. You know what that's not a bad idea for? Someone who's not detail-oriented, who's an ADHD person, who forgets things, and he gets disorganized. So, there's this thing where you're like, “Okay, there may actually be a balance going on. Can we make the balance a little bit better?” So, how do you organize yourself? MEDICATIONS FOR ADHD Right now, there's a stimulant shortage. Stimulants are the most effective medication for reducing ADHD symptoms. They are the most effective biological intervention we have to reduce the impact of probably any psychiatric condition, period. They are incredibly effective, like 80, 90% resolution of symptoms, which is great. I mean, that's great. That's great news. But you also want to be integrating some lifestyle changes and skills alongside of that. So, how do you organize yourself better? I mean, that's like a whole talk, but like lists, prioritizing lists, taking tasks, breaking them down into smaller and smaller pieces. Where do you start? What's the first step? Chipping away. You know what? If you only go one mile a day for 30 days, you go 30 miles. That's still really far. I know you would have gone 30 miles that day, especially if you have ADHD, but you're still getting somewhere. And so, that kind of prioritization is really, really important. And so, you can create that on your own. There are CBT-based resources and things to try to help with that. There are ADHD coaches that try to help with that. It's consistency and commitment around that. So, how do you structure your life for yourself? That poor PhD candidate really needs to structure their life because there is no structure to their life. The other things we want to think about with that, I mean, really good sleep, physical exercise. People with ADHD, we see on FMRI scans when you scan someone's brain, there's less density of dopamine receptors, less dopamine activity. You want to get that dopamine up. That's what the medications are doing, is predominantly raising the dopamine. So, physical activity, aerobic exercise, in particular, is going to do that. Get that in every day, and look, it's good for you. It's good for you. There is no better treatment for every condition in the world other than exercise, particularly aerobic. It basically is good for everything. If you just had surgery, we still want you to get out and walk around. Really quickly, that actually improves your outcome as fast as possible. So, those are the things I like people to start with if they can do that, depending on the severity of what's going on, the impact, what other things have already been tried. Stimulant medications or non-stimulant medications like Wellbutrin, Strattera, Clonidine are also pretty effective. Methylphenidate products, which is what Ritalin is. Adderall products mixed in amphetamine salts, Vyvanse, these are very effective medications for it. There's a massive shortage of these medications that people are constantly talking about, and is really problematic and does not appear to have an endpoint because the DEA doesn't seem ready to raise the amount that they allow to be made because they are still recovering from the opioid crisis, which is ongoing. And so, they're worried about that. Really, they want to be very thoughtful about this. These medications have a very low-risk potential for misuse. In fact, people with ADHD, they appear to reduce the risk of developing a substance use disorder. It's the most common thing that people worry about. So, treatment actually reduces that. That said, the worst -- I mean, I don't want to say the worst thing. I mean, people hate me. The really not great way to get psychiatric treatment is to show up to someone once and then intermittently meet with them where they write a prescription for a medication for you that's supposed to help you, and stimulant medications are included on that. So, that's probably why I didn't lead with that, even though there's actually more science to support them, is that by themselves, it's really going to limit how much help you're going to get. Kimberley: Can you share why? Ryan: Because you need to understand your condition, because you need to spend time with your clinician learning about your condition and understanding how it's affecting your life, and understanding how the medication is actually meant to be a tool. It should be like wearing glasses. It doesn't do the work for you. It doesn't solve all your problems, but it's easier to read when you put your glasses on than without it. It supports you. You still need to figure out how to get these things done. It lowers the activation energy associated with it. But you also want to monitor it. You can't take these medications 24 hours a day and just be ready to go and work, which is things that people have tried. It doesn't work because you need to sleep, because you will die. They've tried this. We know that you will literally die, like not sleeping. And in the interim, you are damaging yourself significantly. So, taking it and timing it in an appropriate way, still getting sufficient sleep, prioritizing other things—they are like a piece of a puzzle, and they are a really powerful piece. But you really don't want that to be the only thing driving your decision-making, or that be what the interaction is really about. And by the way, the same thing is true for all psychiatric medications. Kimberley: I was going to say that's what we know about OCD and anxiety disorders too. Medication alone is not going to cut you across the line. Ryan: And for most people, therapy alone is also not going to cut the line. You have to have a mild case for therapy alone to be okay. And I can trouble for that statement. But the other thing is lifestyle. What lifestyle changes can I make? And those together, all three, are going to mean that you get better faster, you get more better than you would have, you're more likely to stay better. And they start to interact with each other in a good way, where you get this synergistic effect of ripples of good things happening to you and personal growth. You look back, and you're like, “Geez, I'm on version 3.0 of me. I didn't know that there was a new, refined personal growth version of me that could actually function much better. I didn't actually believe that.” DOES ADHD IMPACT SELF-ESTEEM? Kimberley: Well, especially you talked about this impact to self-esteem too. So, if you're getting the correct treatment and now you're improving, as you go, you're like, “Okay, I'm actually smart,” or “I'm actually competent,” or “I'm actually creative. I had no idea.” Ryan: Yes. “I'm not stupid.” Lots of people with ADHD think they're stupid. Kimberley: Yeah. So, that's really cool. One question I have that's just in my mind is, does -- Ryan: And that should be part of your treatment, is the working through. That was essentially a complex trauma. It's the complex trauma of having this condition that may not have been treated that made you think that you were an idiot because you were being shoved into a situation that you did not know how to deal with because your ADHD evolved to be an advantage for you as a hunter-gatherer for the hundreds of thousands of years that we had that, and that modern world is not very compliant for. It doesn't experience you as fitting into it well. And then you feel bad about yourself. ADHD IN MALES vs. FEMALES Kimberley: Right. You're the class clown, or you're the class fool, or the dumb girl, or whatever. Now, my last question, just for my sake of curiosity, is: does ADHD look different between genders? Ryan: This is an area of significant research. So, historically, the party line has been that ADHD is significantly more common in boys and girls. And the epidemiology, the numbers, the prevalence have always supported that. Like 3 to 1, 2 to 1, like a much more, much more common. Refining of that idea has come up with a couple of thoughts. One, for whatever reason, I don't know how much of this is genetic. I have no idea how much of this is environmental, sociological. All other things being equal, after a certain young age, girls just always seem to be ahead of boys in their development. I mean, talk to any parent that's had a lot of kids, and they'll tell you that they're like, “I don't know why the girls are always maturing faster.” So, that's a bias that is going to always make at any given point. The boys look worse because their brains are not developed. So, they're going to be -- remember that immature younger thing? They're going to be immature and younger. And so at any given marker is that. The other thing that's come up is that the hyperactivity seems to be something we see a lot more in males than in females. That's another thing. And versus inattentiveness, which you see in both and is usually the predominant symptom. And the kid who gets noticed is the little boy who's like -- I mean, not that you could do this in today's world, but has scissors and is about to cut a kid's cord. I'm trying to make a silly imagery. That kid's getting a phone call. No one didn't notice that. The whole class called that. Whereas like daydreaming, I'm not really listening—this is a more passive experience of ADHD. And they're not disrupting the room. Forget about the gender thing. Just that presentation is also less noticed. So, I think the answer is the symptomology presentation is a little different. It tends to be predominantly hyperactive. Are the rates different? Yes, they're probably not as wide of a difference as we think they are, because we're probably missing a good number of girls. Are we missing enough girls to make it 50/50? I don't know. That would be a lot of -- it's a big gap. It's not close. It's a pretty big gap. Maybe we're certainly missing some. And then the other aspect of it is particularly post-puberty. Even before puberty, there's hormonal changes going on. And these hormones, particularly testosterone, which is present in everyone, we think about it as a male thing, but it's really just like a balance thing. You have significant amounts of both. It affects a number of things, and attention is one of them. So, there's so many complexing factors to it. That's why I said, it's something we're still trying to sort out. One of the things that's really interesting that goes back to the hormone thing is that if you talk to young women— so postmenstrual, they've gone through puberty—they will tell you over and over again that their symptomology, just like we have mood symptoms tend to be worse during that time period of when you're ovulating, the ADHD symptoms will be worse as well. And so, there's increasing evidence that if you're on ADHD medication and you have ADHD, which again, we're making lots of presumptions here, go get that confirmed, guys. But if you're on that time period just leading up to ovulation a little bit after, you may actually need a higher dose of your medication to get the same effect. That there's something about the way progesterone and whatever is changing that it affects functionally your attention and your experience of your symptomatology. Kimberley: Interesting. Yeah, thank you for sharing that. Is there anything you feel like we've missed or a point you really want to make for the folks who are listening who are trying to really untangle, like you said, that imagery of untangle, anxiety, ADHD, all of the depression, self-esteem? Ryan: This is like a sidebar that's related. So, one of my other areas of interest is cannabis. And here in New York, we've had a lot going on with cannabis. And there's a lot of science going on around, can cannabis be used to treat things, particularly psychiatric disorders? And I know that a lot of people are interested in that. One of the things that I've been really trying to caution people around with it is that the original thing that I was probably taught in the ‘90s about cannabis, marijuana being like this incredibly unsafe thing, is not true. But the narrative that it's totally fine and benign is also not true. And that it is probably going to be effective in reducing anxiety acutely, and it will probably be effective in maybe even improving your mood. And some people with ADHD even think it improves their attention by calming their mind. I am very cautious about people starting to use that as part of their treatment plan. And I can tell you why. Kimberley: Because you did say there's an increase in substance use. Ryan: The problem is that it's not rolled out in a way that reflects an appropriate medical treatment. So, if you do it recreationally, obviously, it's basically like alcohol. You just get what you want, and you decide what you want. If you do it medically, depending on the state, as a general rule, you just get a medical card and then you decide what you're going to do, which just seems crazy to me. I mean, you don't do that. You don't send people home with an unlimited amount of something that is mind-altering and tell them to use as much as they need. And the potencies, the strength of it has gotten stronger and stronger. And so, I really caution people around this because when you use it regularly, what ends up happening is you get this downregulation, particularly daily use. You get this downregulation of your receptors, your cannabinoid receptors. We all have cannabinoid receptors. And you have fewer and fewer of them. And because you have so much cannabinoid in your system because you're getting high that your body says, “I don't need these receptors.” So then when you don't get high, those cannabinoid receptors that modulate serotonin, dopamine—so functionally, your attention, your mood, your anxiety level—there's none of them left because they've been getting bound like crazy to this super strong thing. And you're making almost none yourself, so you're going to feel awful. You're going to feel awful. And it's not dosed in any kind of appropriate way. We're not giving people guidance on this. So, I really caution people when they're utilizing this, which the reality is that a lot of people are, that they be thoughtful about that and thoughtful about the frequency that they're using and the amounts that they're using, and if they're at a point where they're really trying to self-medicate themselves, because that can really get out of control for people. They can get really out of control. And I think it's unfortunate that we don't have a better system to help people with that. That is more like the evaluation of an FDA-approved medication or something like that has a system through it. So, I just wanted to add that because I know this is something that a lot of people are thinking about. And I think it can be hard to get really good science information on since there's a big movement around making this change. When we're doing a big movement around pushing for a change, we don't want to talk about the reasons that the change might be a little problematic, and therefore slow the change down. So, we forget about that. And I think for the general public, it's important to remember that. Kimberley: Yeah, I'm so grateful that you did bring that up. Thank you. Where can our listeners learn more about you or be in touch with you? Ryan: So, if they want to learn more about my practice, my clinical practice, integrativepsych -- no, integrative-psych.org. We changed. We wrote .nyc. There we go. And then if you want to learn about my science and my lab and our research, which we also love, if you just go to Sultan (my last name) lab.org, it redirects to my Columbia page, and then you can see all about that and send some positive vibes to my poor research assistants that work so hard. Kimberley: Wonderful. I'm so grateful for you to be here. Really, I am. And just so happy that you're here. So much more knowledgeable about something that I am not. And so, I'm so grateful that you're here to bring some clarity to this conversation, and hopefully for people to really now go and get a correct assessment to define what's going on for them. Ryan: Yeah, I hope everyone is able to digest all this. I said a lot. And can hopefully make better decisions for themselves for that. Thank you so much. Kimberley: Thank you.
One-on-one pod: Chris is in New York, and Jason is home in Glendale. We chat about missionary hotties, Ball*rina Farms, noontime martinis, Redd Lasso, how to listen to the new Future & Metro Boomin, a dinner party with Kelly Oubre Jr, Kendrick's Big 3, Dr. Dre's Hollywood star, Ad*m 22, Eminem is too rich to have a Just For Men beard, perverts killed Airbnb, Dear Media scene report, tonight we let the Wellbutrin speak, mental health personified, and Team Breezy hits the road. twitter.com/donetodeath twitter.com/themjeans Learn more about your ad choices. Visit megaphone.fm/adchoices
These are two cases where the subject took Wellbutrin (Bupropion) and went through some sort of psychosis, whether intentionally or unintentionally.
Platonic Life Partner and The Pod Captain Erin Foley and Doug Benson join Arden and the Production Team to break down Joey's HOMETOWNS!! Nice Dads! Nip Slips! Rancho Cucamonga! - Arden AND Erin AND Jim all think Kelsey's dad should be the Golden Bachelor! - Erin wants to see Arden on Wellbutrin! - Doug thinks ALL of the families are Kelsey's family! All that plus........TWEET OF THE WEEK!See omnystudio.com/listener for privacy information.
We are excited to bring this Back For Seconds episode to the main feed! Sami interviews journalist - and former Betches intern - Emmeline Clein about her book Dead Weight, which traces the cultural and medical history surrounding eating disorders. Emmeline shares her personal experience with anorexia and shines a light on how the medical community has historically dealt with eating disorder treatment poorly. Sami and Emmeline ruminate on how eating disorders have been glamorized in the media as a “rich girl” thing, and the two have a stimulating conversation about Wellbutrin's marketing as the “happy horny skinny” pill. Learn more about your ad choices. Visit megaphone.fm/adchoices
Hello friends! In today's episode, we delve into two compelling listener questions that I'm sure many of you will find relatable and insightful. Navigating Therapy with a Talkative Therapist: One listener shares their experience with a therapist who often overshadows the session with personal stories, leaving them feeling unheard. This is particularly challenging as the listener is dealing with a controlling spouse with dementia. We explore the importance of feeling heard in therapy, the role of therapist's self-disclosure, and the value of assertiveness in therapeutic relationships. We also discuss the concept of transference and how it can impact therapy sessions. Considering Alternatives to Adderall: Another listener seeks advice about a close relative looking to taper off Adderall, which they've been dependent on for managing ADHD. We discuss the complexities of ADHD diagnosis and treatment, delve into the pharmacology of Adderall, and explore its side effects and potential for psychological dependence. Additionally, we examine Provigil (Modafinil) as an alternative, highlighting the differences in abuse potential and side effects. We also touch upon other medication options like Strattera, Intunive, Clonidine, and Wellbutrin, and emphasize the role of therapy and coaching in managing ADHD. As always, your questions and stories bring a depth of understanding to our discussions. If there's something on your mind, don't hesitate to reach out at duffthepsych@gmail.com. For full show notes, please visit http://duffthepsych.com/episode375. --- This episode is brought to you by Babbel, the science-backed language-learning app with quick, 10-minute lessons tailored to your level. Get 55% off your subscription at babbel.com/duff and start speaking a new language in as little as three weeks. Rules and restrictions may apply. This episode is also sponsored by BetterHelp, the convenient online therapy service. Reflect on your strengths and build on them with a licensed therapist, tailored to your needs and schedule. Visit betterhelp.com/duff to get 10% off your first month and start celebrating your progress.
Hello friends! In today's enlightening episode, we delve deep into the intricacies of neurotransmitters, specifically dopamine, and their impact on our behavior and mental health. We also touch on trichotillomania and the role of medications like Wellbutrin in treating such conditions. Demystifying Dopamine and Serotonin: We kick off by addressing a common oversimplification in the world of mental health. Dopamine and serotonin are often reduced to mere 'happiness' and 'reward' chemicals in popular culture. We explore how these neurotransmitters are far more complex and play a variety of roles in our body, from movement and mood regulation to learning and memory. Understanding Neurotransmitters: What exactly are neurotransmitters like dopamine? We explain their crucial role in brain communication and their diverse functions. We also discuss other key neurotransmitters such as serotonin, acetylcholine, epinephrine, norepinephrine, GABA, and glutamate. Dopamine's Role Beyond Pleasure: Moving beyond the 'feel-good molecule' tag, we delve into dopamine's involvement in anticipation of rewards, motivation to pursue goals, and its critical role in learning and habit formation. Impact of Modern Habits: How do activities like scrolling on social media, playing video games, or watching TV series influence our dopamine levels? We discuss how these activities engage our brain's reward system and the concept of negative reinforcement in avoiding stress or emotional discomfort. Trichotillomania and Dopamine: Addressing a listener's specific concern, we explore trichotillomania, a complex mental health condition involving recurrent hair pulling. We examine the potential roles of dopamine, serotonin, glutamate, genetic factors, and environmental influences in this disorder. Wellbutrin - A Closer Look: What about medications like Wellbutrin? We clarify how Wellbutrin, or bupropion, an NDRI, differs from other antidepressants and its effectiveness in treating depression, aiding smoking cessation, and its potential implications in treating trichotillomania. Final Thoughts and Recommendations: We wrap up by emphasizing the importance of seeking professional advice for personalized treatment plans, especially for conditions like trichotillomania, and encourage listeners to keep sending their thoughtful questions and topics. As always, you can send me your questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode380 ---- The new year isn't all about change. Keep and build upon your progress with the help of a licensed therapist through BetterHelp. You can get 10% off your first month at http://betterhelp.com/duff
It's crazy to think about how anxiety is one of the top two causes of seeking medication in the US. The numbers may be staggering but when you really think about it, it makes sense considering the fast-paced, uncertain world we live in. But while anxiety drugs like Wellbutrin have done wonders for some, it also causes worrying side effects, dependence, withdrawal issues and other negative consequences. In this episode, Ani Anderson and Brian Trzaskos dig into the science behind how Wellbutrin works. They explain how our body is already equipped to do what Wellbutrin does, only in a much better, much safer way. They also discuss the benefits of somatic coaching on anyone suffering from symptoms of anxiety. Tune in and learn more!
Kelly and Leandra finally break what was left of their tenuous tether to reality and give voice to their imaginary friends. They also begin their multiple-episode journey into the details on Frank's jacket! Questions? Comments? Money for our therapy copays? Email us at rockyhorrorminute@gmail.com and leave us those happy 5-star reviews because they're almost as good as Wellbutrin to us (almost). Also don't forget to send us your address for an official Rocky Horror Minute Christmas Card! --- Support this podcast: https://podcasters.spotify.com/pod/show/rocky-horror-minute/support
Jen Thomas Bidwell Mother of Son Terron Evans R.I.P.The silence ends now. I am the BLM Potsdam NY Organizer in St.Lawrence County(the largest county by area in NYS, One of the most racist counties if not the most in NYS) . My 26 year old son Terron Evans Jr.moved here to Potsdam NY in June 2020 and is now dead of a supposed overdose of Wellbutrin pills. His girlfriend who has a relationship with the Potsdam Police,who I've been going up against for over a year for the justice of Garrett Phillips were the first responders on the scene and the ones to never call or come by to tell me about my son.I have many reasons to believe there was foul play. Regardless of how my son died,he was turned down,denied,abused,rejected,by our systems pretty much all of his life, that I thought were supposed to help him/us,but did not.Terron decided to move here instead of back to his hometown of Syracuse NY to stay away from the drama,but it was almost impossible for him to get on his feet here being a black man.The following is why I believe foul play may have occurred and most definatly Systemic racism is part of why my son is dead.12 year old Garrett Phillips was strangled in his apartment at 100 Market St Potsdam NY on October 24th 2011(there are many many media outlets and podcasts around the world that covered this case,because of the treatment of Nick Hillaary,misconduct and incompitence of the Potsdam Police and the modern day lynching of a black man).Imediatley Garrett's mother's black ex boyfriend Nick Hillary was considered a suspect.Nick was asked to go to the police station to go over a list of kids names.It was an interrogation.He was detained,made to completley strip necked and be photographed from head to toe.His phone and other belongings were taken and he was given a hasmat suit to go home in.Nick was indicted twice.The first time it was thrown out because of lack of evidence and misconduct by the Prosecutor Mary Rain.The second time he was found not guilty by the judge and Mary Rain's law lisence was suspended for two years because of her misconduct(including withholding information by a witness from the defense attorneys because it did not go with her theory).PLEASE WATCH THE 2 PART HBO DOCUMENTARY WHO KILLED GARRETT PHILLIPS(it can be watched on YouTube).Garretts mother's other ex boyfriend Deputy Sheriff John Jones (who was close friends with Mark Murray,then lead investigator in the murder,now Potsdam Police Chief)was also a suspect.He was allowed to participate in the investigation from the very beginning.He accompanied Garrett's mother Tandy Cyrus(despite Tandy previously fearing for her and her boys saftey of John Jones) the following morning to the police station for her questioning.."John Jones" had pictures of his feet and arms taken.Fully clothed and no face included in the photos.A child was murdered,the police made errors almost from the time Garrett was found on the floor in his mother's room,there was misconduct,not following other leads throughout the years and Garrett's killer evaded justice.The Potsdam Police still say that Nick is the one that murdered Garrett,therefore have not taken leads seriously.I have asked the current DA Gary Pasqua(Who will be running for DA again) to do a Sentinal Event Review,he refuses.I have asked him to refer the case to the Attorney general for an independent investigation,he refuses and he said that the State Police are the independent investigation.The State Police were involved in the investigation from the day Garrett was killed.They also have close ties to the Phillips family and commuity.I have Asked Gary if he would make a public statement announcing that leads should go to the State Police and not the Potsdam Police(the justice for Garrett Phillips sign and billboard say to call Potsdam Police with information)but he refuses.I was on the Committee for police reform in Potsdam NY,but resigned recently last year because my concerns of racism and bias within the Potsdam Police department and community were not being taken seriously,shot down and even ignored.TThis show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/1198501/advertisement
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