Podcasts about wellbutrin

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/    

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

Mindy answers questions about the Flu, Wellbutrin, Strep throat, Barely Brooks, Shoulder pain, abdominal surgery and pregnancy, Ozempic burps, PCOS, Nutrafol, red moles, Toby Keith, tonsils, mystery sore throat, chronic UTIs, back pain, ADHD, bed-wetting, water fast and other fasting. See omnystudio.com/listener for privacy information.

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

If Christianity ever stops being weird, it will no longer change lives. So let's get weird.I knew that the childhood mantra of “Believe in yourself” had failed in the crucible of reality. That turned out to be a bad drug, like the brown acid that the 1960's burnouts spoke about. Work and career couldn't save me. Money couldn't either. The old trusty sidekick, liquor, was as worthless as ever now. These were all bad drugs. While I had flung beer bottles at religious people for using God as a crutch, I was leaning on various crutches, and when those crutches failed, anti-depressants became the crutch. At this point, I still had no idea that I was soul-sick far more than physically or mentally impaired. On particularly blue days, or “Black Dog” days as Winston Churchill called them, or the days when the “Noonday Demon” of acedia overtook me, I knew that something was missing. And after a few years working as an engineer, I realized that I needed to talk to a doctor. And the doctor had the cure. Then I heard the new pitch for the new drug. I needed a supplement to believe in myself. It was medicine, just like insulin. Surely a diabetic would not refuse the medicine that would save his life, so why would someone deficient in a neurotransmitter not trust that pharma solutions could save me? Here existed a scientific, peer-reviewed solution, and it came in the form of a pill that would simply re-balance the chemistry in my brain. Just eat this little dot once a day and like Dorothy I would be back in humanist Kansas. Never mind that humans had lived for tens of thousands of years without these pills - this was the only solution. The fix was merely a matter of dialing in the numbers, like getting the chemicals correct when balancing a pool PH level. It was easy! There were also techniques, from Cognitive Behavioral Therapy and its cousins like RET, and there was pseudo-spiritual self-affirmation options in Buddhist meditation (heavy on the self), and then there was the budding “science” of taking LSD. There was a pill plus technical methodologies to deal. I just needed an action plan for mind and body (no soul needed). Pills are goodSo the days of anti-depressants began. In a pill came the solution, and I convinced myself after a month it “seemed to be working” since I felt “not quite as irritable.” However, today I am certain that if the doctor had given me a magical bag of potato chips in a medical looking package, and had told me to eat one a day, it would have had the same effect. Because I wasn't feeling any different. The Black Dog days still arrived and struck hard. That was when I was told that the dosage just needed to be increased. More was better…you see…I needed two magical potato chips per day, not one. This is becoming more well known as people are beginning to realize that the modern SSRI pill solution is just another version of snake oil. What I discovered after about five years is that I could not stop taking these pills, because if I stopped, I became so dizzy that I could hardly stand. Getting off the anti-depressants now felt as hard as quitting tobacco had been. In the early years of taking anti-depressants, I was still drinking, which in hindsight is insane to me. But after I did quit drinking (a topic I covered at great length in the initial series of this site), I continued with the pills. After a few years of sobriety, I tried to stop taking the pills, and the dizziness gave me such fear that I worried about slipping into some suicidal despair, so I stayed on the pills. This certainly works in favor of the pharmaceutical companies. I continued on the pills, sober, believing that I needed them. Life without liquor started by asking God for help. Getting back to the basics of belief in God set me free from drinking, to my utter and complete surprise. The only way that I ever got sober was by doing the exact opposite of everything that I had learned in school. “Believe in myself” turned out to be the very thing that was destroying my liver and overall health. How many hundreds of times did I try to will myself to stay sober and it failed? Then suddenly, by simply asking God for strength and direction, I was making it through a day, and another day, then a week, then a month. But then I stopped praying for a long spell, not able to connect the dots. I stayed sober for a year before falling into the usual trap. “I got this now. I believe in myself.” Yes, that was the road back to ruin. I started with non-alcoholic beer then switched to regular beer and a year or two later I was worse off than before. Then a night in jail and the threat of more rehab got me back to the basics, of the need for God. But this time I knew that I needed God more than he needed me. But I still didn't need him that much. I had my pills.The pills carried me through some more years, but I was back in motion. In addition, fitness became an interest and continued until I'd run some eight or ten marathons and did an Ironman. I thought I'd fended off the emptiness forever. But it was after the Ironman in 2019 that it struck back, and harder than ever before. The depression arrived and I knew that I had cured nothing. I could not save myself. I could not manufacture self-esteem. Cognitive Behavioral Therapy was a parlor game. The pills were doing nothing. The fitness had maxed out. I was still on the treadmill of self-esteem. Not even a long period of sobriety was a cure. There had to be something more. Body and SoulThat is when I understood the soul. For the first time in my life, I realized that we are body and soul. I had inklings about it, in times when I'd felt I'd lost something. In the deadness of my heart, I had always known something was off, ever since middle school. The comment from Jesus: “Let the dead bury their dead” always shocked me. But I knew what he meant. I knew that he meant the people who never came to know Him. Because until I learned to kneel and pray and ask for God's forgiveness, I never knew what redemptive suffering meant, and I never knew why he had to go through the cross to be resurrected. Even this process took time because I was so blind to my spiritual state, that I couldn't even see my sins and the wreckage of my life that had piled up in the wake of my jetboat named “Believe in yourself”. The next four years began a long process of spiritual awakening, in a way that I could never have understood or predicted. Even as it happened, I tried to resist it. Sneaking into back rows of churches, I was there for reasons I could hardly fathom. But I knew there was something needed, something desired. A Sunday morning watching Netflix no longer satisfied me. It had never satisfied me, I was just finally becoming aware of it. I started saying “Yes” to prayer, to fellowship, to volunteering, and to meet people who believed, and I mean really, actually believed in a spiritual life. The supernatural became revealed again through the witness of others, and I too started to tear down the walls of my materialism and unbelief. The propaganda of the Humanist Manifesto that had been drilled into my head scattered. The false foundations of my public school and media indoctrination started to erode and crumble like sand. And because the believers were living differently from everyone I had chosen to spend time with since middle school, I had to “come and see” what they were doing. It was so different. Their lives were different. Their thoughts are different. Most of them had less money than me, but they had something that I could never get. They had a sense of rest, of peace. And as I got to know them, I learned something interesting. They all spent time in prayer, every day. None were on anti-depressants. Not one of them “believed in themselves.” No, that was crazy. No, instead they all believed in God, and the Resurrection of Christ. I knew many other people who seemed to be living without God, but they were taking pills, or smoking weed, or drinking, or chasing a dollar, or obsessing with sex. But here was something different. Here was a free option, called grace. No pills needed. Then I read G.K. Chesterton's Orthodoxy and the second chapter confirmed what I had known by experience but could never articulate. This is a book about the concept of “Believe in yourself.” The second chapter is called “The Maniac,” and the maniac is the man who “believes in himself.” Chesterton says, “Believing utterly in one's self is a hysterical and superstitious belief.” I straightened up in my reading chair, as so much of the era from the 1970s to 2020s that I had lived within began to make much more sense. When I was born, the humanists had overrun public schooling in precisely that era (and even ruled the progressive Churches), and the first rule of the humanists, in their manifesto, was that “Religious humanists regard the universe as self-existing and not created.” Thus it was no wonder that my teachers had ruled out God as existing, as a living entity. My few hours a year in faith formation were trampled over and cast out at the first difficult question I raised about God. My understanding of anything about Catholicism or faith was a house of cards. To make matters worse, I had only attended Masses from the post-Vatican II, where it was more guitar and modern “hymns” than reverent prayer and silence. I am not joking when I tell this: the first time I saw a High Latin Mass, I thought I was on another planet. I had no idea what was happening, but I knew that every Mass I had attended as a kid was lacking seriousness. I didn't even receive Communion that day because I didn't know what the altar rail was for, or why people were kneeling to receive the Eucharist. Probably best I didn't, since I still hadn't understood the need for Confession and being in a state of Grace before receiving the Eucharist yet. I realized after this process had completed, after I had flushed my anti-depressants, that I had to knock down about ten walls of worldly indoctrination and self-deception that had been erected over thirty years, all the way back to Sesame Street with its early onset self-esteem program of indoctrination…and maybe even Tom and Jerry as I loved watching them beat the hell out of each other and figured that both and Tom and Jerry believed in themselves.First, I had to accept that God may exist. This meant overcoming the dogmas of academia, that had coached me into the negative position, and until I found Aquinas and Augustine and Pascal and Robert Barron, I had never heard of the compelling arguments for the affirmative. But it wasn't an argument that made me believe that God may exist - it was the first time I tried prayer and was able to not drink. And this will forever be perhaps the strangest education of my life. For nothing had worked before - no amount of knowledge, no technique, no bargaining, no rewards. Later, I used prayer to discontinue looking at any smut on my computer or phone, and lo and behold, repeatedly kneeling and asking God for help, once again, chased away the demon. This had a profound effect on me, as I realized that prayer did something strange, and it was real. Then there was politics, which is always the top idol in America. You can't bring up a news story in most circles without hitting an electric wire related to politics. The issue of abortion or prayer in schools was a trigger for me, as I had been coached well enough in school that liberty and freedom only meant doing whatever one wished. Luckily, over the years I had lived in neighborhoods with people of both parties, so I had close friends of both the left and the right, and I still do, and this is because I have the gift of knowing when to shut the hell up. My 10th-grade biology teacher once paid me a great compliment, telling me that I was a nuisance in class, but I knew when to quit. Now, for some, that may not sound like a compliment, but to me, it meant I had the slightest sense of knowing when to stop acting like an idiot. Perhaps being from Minnesota had something to do with it because we hold back our feelings to avoid offending others - or we did at one time. I think that has passed as greater America has infected the state through social media. However, when I began to believe in God, I began to set aside certain political issues, such as that unborn babies are “just a clump of cells,” which never made a lot of sense to me anyway. The problem was that if I had a soul, then so did everyone else. If I had a soul, so did my conservative and liberal neighbors - they both did. And if I had a soul, so did babies, and if babies had a soul, so did humans who had not yet popped out of the womb. Plus I had my own children and they were the greatest gift, along with my wife, that I could have ever asked for, and I hadn't asked for, yet had been given them. And all of these things began to work like a degreasing rust remover on my static and crusty ideas. The bolted-on beliefs from college and my twenties started looking less solid. That wall of politics may have been as thick as the wall of “Does God exist?”Then there was the approval of the world - a very thick wall - because to believe in God was to reject the secularization thesis that reigned in the last fifty years. Belief in God was a vestige of less sophisticated times. It was like the appendix on the body, or goosebumps - they were leftovers from a more primitive age. Joseph Campbell and many others assured us that Christianity was just like every other religion, every other myth, with just a wrinkle of difference here, a nuance there. I felt like the world was nudging me along, saying, “Nothing to see here, folks: Star Wars is sufficient for your spiritual needs.” Except it wasn't (and Disney's takeover of it has certainly proven that out as it degrades with every new release).To be Catholic, or really any non-”progressive” Christian, was to be a modern freak. It was not approved of by the educated and cool people. I liked reading Reddit, which was like the atheist training ground of the internet. On Reddit people could be anonymous and bash the church openly, and all of the veiled arguments against Christianity in the media and college were unleashed in their full anger online. Oh, and Islam was the true religion of peace - all of Christian history was to blame for every injustice in the modern world. No, I believed that. In hindsight, it's amazing how far your false teaching can take you, and it's no wonder to me now that the books of the Church Fathers are swept under a rug. To read Augustine's Confessions, or Origen's First Principles, or the story of the martyrs of Lyon, or hear about the Battle of Tours and the Battle of Lepanto, or read of the martyrs like St. Lawrence and St. Agnes, or to see the early church in the letters of St. Ignatius of Antioch - all of this is more thrilling than any roller coaster at Six Flags. As I started to read the Gospels and read the writings of the Church Fathers and listen to Bishop Barron, as well as the Lord of Spirits podcast, Tim Keller, Father Mike Schmitz, and more - I knew that I had not been told anything about the history of Christianity. The education system, from kindergarten to college, had hidden a trove of books from us. Purposefully it had steered me away from millennia of wisdom. All spiritual things were kept away, all of the things that held Christendom together. Even the dichotomies were false ones: I had only ever heard of nature vs. nurture, as if all problems were merely questions of genetics or environment. As if only those two things could be the cause of human sin. They walled off “The Fall” as a non-possibility, and in walling it off proved in the 20th century experiments of communism, fascism, and liberalism that nature vs. nurture did not account for all problems. The longer you look into the abyss, the more you know The Fall happened. But the education system blamed other things. Never was it the world, the flesh, and the devil that prompted us to sin. Never was it the idea of concupiscence, a word that I didn't learn until my late thirties. Worse, there was a false war over faith vs. reason, and until digging deeply I learned that not only was this an invention of the Enlightenment, but the people beating the drum of that war were standing on the shoulders of the giants of faith who used their reason to discover the wonders of the natural world while still having full faith in God. There was no conflict between faith and reason. The fundamentalists and atheists may have had some odd war over those two things, but Catholics did not. The wisdom of the Saints was kept like dry goods in storage. But the great thing about it is that just when all the bad movies and boring bestsellers had lost their flair, I stumbled onto St. Augustine, St. Ignatius of Antioch, St. John Damascene and realized that there is absolute dynamite in the word of God and the history of the church. I remember reading The Imitation of Christ on an airplane and thinking, “I should hide the cover or these people will think I'm a crazy Christian.” That was an odd thought. In fact, I now know who put that thought in my head. I had never once thought that I should “hide the cover” when I was reading Ovid or Virgil on a plane. I never thought that when reading Richard Dawkins or Christopher Hitchens. And so it occurred to me that the real rebel today is the one who reads The Imitation of Christ. The only books I was embarrassed to be seen with were the ones that felt like they inverted the whole world that I had come to accept. And the fact that invasive thoughts were suggesting that I stop reading it or hide it hinted to me that the nature of thoughts may not be purely material things. After all, thoughts are only in the intellect, and angels are pure intellect - as are demons. Oddly enough, this open reading of books written by early Christians felt like an act of revolt against the world. As a child of the 1980s and 1990s, I tend to like a revolt now and then, but this was the first revolt against the world instead of God. Now I was repenting, turning back. I think when we 90s kids were drinking like fish and head-banging, we were only doing so because we had never seen beauty or truth, never heard it, never understood it, never encountered it. We were raised with ugly buildings, ugly art, and ugly ideology. Given the choice today between listening to Metallica's “Master of Puppets” or “Jesu, Salvator Mundi” from the Benedictines of Mary, Queen of Apostles - ten out of ten times, I choose the nuns. (Sorry, Hetfield, you've been replaced. Those women need no distortion pedal or even guitars to outdo you. Thanks for all the metal, but I'm all good now.) Punk is done, rock is dulled: beauty, truth, and goodness is new again. Why? Because God makes all things new. Many of us who grew up in the late 20th century and early 21st century have never seen or heard such things. Irreverent Masses and the pop music hymns are all we were shown. We are so accustomed to ugliness that we don't even know it until we start digging in the past to see what “The Enlightenment” tried to bury. There is much more out there than the material world. There is new life in Christ. Life is not just biological or psychological, it is spiritual, it is Sacramental. “Something shook out of me”After I started seeking God, which came in incremental steps, there were two days when the world of ghosts and spirits became real to me in ways that I cannot account for. The first was an out-of-body experience I had in a doctor's office, when I was being told something and could no longer hear the doctor. For a brief period, I felt as if floating in the room, or absent from my body. This may have lasted only ten seconds, but in those ten seconds, I caught a glimpse of a reality outside of the body. Nothing dramatic happened, I just felt a separation from my body and recognized that the soul can live outside of the flesh. This made apparent the need for change, for the animating, the soul, seemed to be separating for the sole purpose of telling me, “Here I am. This is the self you thought was you. This is your soul, and your body is down there. You need to acknowledge me.” This startling experience rocked various assumptions I had about the material world. Already I had known that through prayer, somehow, someway, I could resist temptations like alcohol that otherwise drove me to madness, that I could never stop on my own. But the second experience showed me that the concept of possession is real. Again, I am at a loss for an explanation for this, but the day this happened is the day that I began to read the Bible and see it completely differently. I was at home. Because I had been learning about God and catching up on reading the books I had never been exposed to, I took a moment to watch a show about Catholicism, called Symbolon. Now, Edward Sri is not a speaker or teacher that I am drawn to, but it is he who changed my life by merely speaking words - not even to me, but in a recording - and what he said caused something to leave my body. Again, this is too strange for words, and whatever I make of it here, will fail to tell the ghostly nature of what occurred. I've written about this before but didn't mention the “shaking out” that happened with it. Something left my body, or my soul, or both. It was a word that changed me. Some say that books don't change people; paragraphs do. But for me, it was a single word that opened up the scripture. The word “literarily.” Edward Sri said there is a difference between reading the Bible “literally” and “literarily.” The literal was important, but the spiritual reading I had been ignoring. Reading the Word of God was more than a literal or literary exercise, but somehow the word literary awakened me to understanding that there was a literal and a spiritual way to read. Better still, within the spiritual sense were the moral, allegorical, and the Big Picture (of how it related to Jesus) senses. This was a moment of St. Anselm's “faith seeking understanding,” as the literal and spiritual senses of scripture suddenly flowered. I realized reading the Bible was not an academic exercise, it was a living encounter with the Word of God.It made all the difference in the world to me. When I heard that, something made my ears perk up. Edward Sri had only said this:The Catholic approach to Scripture is different from the fundamentalist view, which reads Scripture in a literalistic way. To discern the truth God put in Scripture, we must interpret the Bible literarily, remembering that God speaks to us in a human way, through the human writers of Scripture. That means that we examine the context and intent of the author for any given passage.-From Symbolon (session 3)This marked the death of fundamentalism, from both sides. The pure materialist science perspective was gone. Any creeping “faith alone” or fundamentalist Protestant reading was gone, too. The four senses of scripture roared from the book. I guess it like how LSD users describe their imaginary worlds coming to life when the hallucinations begin. But I wasn't using LSD. This was a stone sober revelation. This was an encounter. This was the Holy Spirit. I had rejected it for so long, the unforgivable sin, and somehow I now let it in. Or rather, I didn't do anything - God did something. How do I know that this moment in time changed something in me? Because I felt it. And because I've seen it happen to others. In AA meetings you will often hear someone say, “I felt something lifted off of me.” Whenever I hear this, I know that God is working miracles in this world just as he was when Jesus walked the earth, or when Moses heard God thunder on the mountain, or when a dazed Abraham made his covenant with God. There is another saying in AA, and it is, “Don't stop coming until the miracle happens.” Newbies don't know what that means and often find it confusing, if not irritating. But something happens and it cannot be explained in purely rational terms. Something happened. Something strange. Something wonderful.Years ago, when I knew the time to drink was nearing, I always felt a tingle in my forearms. It was like a creepy, crawly feeling - like a temptation or urge or compulsion. There was a sense of a force approaching that could not be satisfied. On that day when something happened, I had been sober for four years at this point, so the writhing feeling rarely ever happened. I was past that. But I was still white-knuckling life on many days. Some days I still live that way. But when I heard the words about how to read the Bible, my hands shook. It was not like an excess caffeine shake, nor was it like a nervous shaking, nor was it like a hunger shake, nor was it like the natural tremor that I have in my hands. Something shook out of my hands, something invisible. This was a violent shake. The shaking lasted perhaps one second. But when it happened, I said, “Yes, that's it.” And I knew. I knew then and there that the reason I had been unable to read the Bible was because I had blinders on from Protestant fundamentalists and atheist scientists who had presented a false dichotomy. There was no war between faith and reason. There was another invisible realm beyond nature vs. nurture. There was a way to read Genesis that made sense. There was a way to know Christ as the eternally begotten Son of God, fully human and fully divine. The world and scripture opened up, spiritual and physical. When it shook out of me I knew what the demoniacs had felt in the Gospels, what Mary Magdalene had felt. Further, I knew what Jesus meant when he said that we must ask, seek, and knock and God will answer, because even though I didn't know what was drawing me, I was no longer seeking myself, I was seeking God. This was a casting out. The shaking that occurred that day altered the course of my life. Many little walls had to come down before that, but that day did something that no book or life experience could ever do. Were it not for the shaking out of something from my forearms and hands, no senses would have caught the departure of this presence that had been over me. Suddenly I could say, “Something was lifted off of me,” but for me it was, “Something shook out of me.” And it was that day that I knew: I no longer needed anti-depressants. I needed prayer, fellowship, scripture, and the Sacraments. I needed God, in the Father, the Son, and the Holy Spirit. I still needed “me” because I knew that I was made for God, and my heart had been restless until it rested in Him. But I also knew that I needed Reconciliation and the Eucharist far more than Lexapro or Wellbutrin. I knew that every misguided search and difficulty had been leading me to that moment. And after that, the moments kept coming where I saw more clearly, such as when I first attended a High Mass in Latin, where I saw how powerful liturgy could be, or when I continued to meet people of faith, or when I kneeled to pray, or read spiritual books, or volunteered for things that I didn't necessarily like to do. A few weeks after that day when “something shook out of me,” I dumped the last of the pills down the toilet. Whatever had shaken out of me seemed to stir the Holy Spirit in me. I felt as if the Baptismal and Confirmation graces were set free. Whatever had been “over me” had departed, and I knew it. And I knew how to keep it that way, through the name of Christ, through prayer and obedience, submission to God. Not through effort, but by surrender. The old “surrender to win” attitude worked. The cure had been to unlearn all that I had ever learned, because once I stopped believing in myself, I believed in God. I knew that the devil was real, and he certainly believed in himself. I knew that sin was real and it was some relative wishy-washy opinion. No longer was I on top. I was in the lowest place, because I knew that spiritually I had long been a sitting duck when I thought I knew more that spirits of pure intellect. No longer did my ideas come first, but I submitted to the teachings of the Church. These rules were not for oppressing but for freedom, the right kind of freedom. Most of all, I knew Who was greater than both the devil and myself. In a great mystery, our trials and tribulations are permitted, because they allow growth to happen. But there is no growth without struggle, and action and humility must be settled into a union. Scripture is alive. God is alive. He is risen. These are all mysteries to embrace. “Surrender to win” must be the way, as the Lord showed us. In the strangest story of all, God became man, was crucified, died, and rose again. At long last, I am alive and no longer looking for the answer in myself, because I no longer believe in myself. I believe in God. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit whydidpetersink.substack.com

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!

Keeley has COVID so here's a blooper reel! Lots of fun moments in this episode, including Ezra singing a lot, Daniel discussing his relationship with Wellbutrin, and Keeley feeling really guilty making jokes about Campbell Saunders! Enjoy! POTENTIALLY TRIGGERING CONTENT IN THIS EPISODE: SU*CIDE, s*xuality, weight, pillow princesses. follow Keeley at: @omgitskee on Instagram and Tiktok  follow Daniel at: @dannyboyherman on Instagram and Twitter follow Ezra at: ezrapartier on Instagram follow the podcast at: @cuckoobananaspodcast on Instagram  email us at: cuckoobananaspodcast@gmail.com  music: ⁠https://www.purple-planet.com⁠  cover art by: Jaime Lee (@nosoyhere on Instagram)

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

I've been racking my brain for a phrase to compete with my favorite "Wellbutrin Wins," to similarly describe my experience with the anti-depressant Lexapro.Wellbutrin, an anti-depressant medication I started a year and a half ago, helped quiet some of the constant panic and terror I felt about every day living. It also helped tune out my sense of everyone else's feelings and needs, so I could better center around my own.Six months later, I worked with my psychiatrist to add Lexapro to the mix. It helped me land in my body, with my thoughts and emotions still vibrant and swirling around me, but no longer sweeping me away.  In this podcast, I talk about situational depression ( 3 months of shoulder pain!), and seasonal depression (bitterly cold and early dark days of winter) crashing together to leave me thinking... "Why Monday?"I don't know that medication will benefit everyone who needs it and tries it. But I do know that it still feels incredibly shameful and scary to talk about needing mental health support. And this keeps people who could benefit greatly from it from even considering it.Depression and anxiety are already such incredibly lonely experiences. And help - whether medication, therapy, exercise, or a combination thereof - can take time to kick in. Staying committed to getting better, when everything already feels so hard, is a true act of courage.Pssst.... now you can also watch the episode on YouTube !#CreatingIsHealing

Ann Bracken has published three poetry collections, The Altar of Innocence, No Barking in the Hallways: Poems from the Classroom, Once You're Inside: Poetry Exploring Incarceration, and a memoir entitled Crash: A Memoir of Overmedication and Recovery (Charing Cross Press, 2022). She serves as a contributing editor for Little Patuxent Review and co-facilitates the Wilde Readings Poetry Series in Columbia, Maryland, and she's a frequent contributor to Mad in America's family section. She volunteers as a correspondent for the Justice Arts Coalition, exchanging letters with incarcerated people to foster their use of the arts. Her poetry, essays, and interviews have appeared in numerous anthologies and journals, her work has been featured on Best American Poetry, and she's been a guest on Grace Cavalieri's The Poet and The Poem radio show. Her advocacy work promotes using the arts to foster paradigm change in the areas of emotional wellness, education, and prison abolition. This interview focuses on Once You're Inside as well as Crash: A Memoir of Overmedication and Recovery. Crash is the story of Helen Dempsey and her daughter Ann who both fall victim to the same regimen of overmedication at the hands of the mental health system. Helen struggles with intractable depression and initially turns to self-medication with alcohol, but finds herself unable to recover despite numerous drugs, hospitalizations, and electroconvulsive therapy. Ann vows to build a different life for herself, but eventually descends into the pain of a mysterious migraine and intractable darkness lasting for many years. She was severely overmedicated with opioids and psychiatric drugs and then Methadone, DHE-45 injections, Migrant nasal spray (for headaches) and injecribele Demerol (for really bad days) once she was off opiates. To keep her out of depression (maintenance), she was prescribed Wellbutrin, Elavil, Topamax, and Valium; Ann crashes her car twice. It took her 4 months of energy healing to discontinue the pain meds and two years later, about a year to get off of psych drugs. Because traditional medical treatments have failed her, she challenges her doctors' advice and discovers ways to heal the source of her physical and emotional pain without drugs. The question of why her mother never got well continues to haunt her long after her mother's death until she finds the missing puzzle pieces she'd searched for all her life stashed in a dusty box in her sister's attic. You can find more about Ann as well as her books and other writings here.  You can learn more about Megan Wildhood at meganwildhood.com. Learn more about your ad choices. Visit podcastchoices.com/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Ann Bracken has published three poetry collections, The Altar of Innocence, No Barking in the Hallways: Poems from the Classroom, Once You're Inside: Poetry Exploring Incarceration, and a memoir entitled Crash: A Memoir of Overmedication and Recovery (Charing Cross Press, 2022). She serves as a contributing editor for Little Patuxent Review and co-facilitates the Wilde Readings Poetry Series in Columbia, Maryland, and she's a frequent contributor to Mad in America's family section. She volunteers as a correspondent for the Justice Arts Coalition, exchanging letters with incarcerated people to foster their use of the arts. Her poetry, essays, and interviews have appeared in numerous anthologies and journals, her work has been featured on Best American Poetry, and she's been a guest on Grace Cavalieri's The Poet and The Poem radio show. Her advocacy work promotes using the arts to foster paradigm change in the areas of emotional wellness, education, and prison abolition. This interview focuses on Once You're Inside as well as Crash: A Memoir of Overmedication and Recovery. Crash is the story of Helen Dempsey and her daughter Ann who both fall victim to the same regimen of overmedication at the hands of the mental health system. Helen struggles with intractable depression and initially turns to self-medication with alcohol, but finds herself unable to recover despite numerous drugs, hospitalizations, and electroconvulsive therapy. Ann vows to build a different life for herself, but eventually descends into the pain of a mysterious migraine and intractable darkness lasting for many years. She was severely overmedicated with opioids and psychiatric drugs and then Methadone, DHE-45 injections, Migrant nasal spray (for headaches) and injecribele Demerol (for really bad days) once she was off opiates. To keep her out of depression (maintenance), she was prescribed Wellbutrin, Elavil, Topamax, and Valium; Ann crashes her car twice. It took her 4 months of energy healing to discontinue the pain meds and two years later, about a year to get off of psych drugs. Because traditional medical treatments have failed her, she challenges her doctors' advice and discovers ways to heal the source of her physical and emotional pain without drugs. The question of why her mother never got well continues to haunt her long after her mother's death until she finds the missing puzzle pieces she'd searched for all her life stashed in a dusty box in her sister's attic. You can find more about Ann as well as her books and other writings here.  You can learn more about Megan Wildhood at meganwildhood.com. Learn more about your ad choices. Visit podcastchoices.com/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/medicine

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

Hey, we're back! I'm so excited to bring you the first of many new episodes in our 3rd season of Focus Forward. Considering it's ADHD awareness month, I wanted to explore something relating ADHD that we hadn't done before. In this week's episode, we're tackling adult ADHD and the life-changing journey of getting a late diagnosis. This episode is particularly special for me as it documents my own personal journey in discovering that I have ADHD (in real time!) This journey of revelation began with a conversation I had last year with Dr. Jan Willer - a clinical psychologist who specializes in supporting those with ADHD. After our conversation, I began to seriously suspect that I, too, might have ADHD. In this episode, we'll explore the difficult question of "do I have ADHD or not?" and the impact that getting a diagnosis can have on our life and sense of self. I hope you enjoy this one! Resources Related to this EpisodeDr. Jan Willer's ResourcesJan's books on AmazonADHD ResourcesAdult ADHD Self-Report Scale (ASRS-v1.1)CHADDAdult ADHD ToolkitBeyond BookSmart's ADHD Success KitHow to Thrive with ADHD After a DiagnosisEp 13: How to Unlock the Superpowers of ADHDWomen's ADHD Wellbeing PodcastContact us!Reach out to us at podcast@beyondbooksmart.comIG/FB/TikTok @beyondbooksmartcoachingTranscriptHannah Choi 00:04Hi everyone and welcome to Focus Forward: An Executive Function Podcast where we explore the challenges and celebrate the wins you'll experience as you change your life through working on improving your executive function skills. I'm your host, Hannah Choi. Hannah Choi 00:18We are back after our summer break. Yay. Today's episode is super special. Not only is it our first episode of season three, but it is also our 30th episode. I know there are podcasts out there with hundreds and hundreds of episodes. But I just have to say I'm super proud of this achievement, and I'm so glad you're here with me today to celebrate. On top of all that fun stuff is also ADHD Awareness Month. In today's episode, I'm going to share some of my own ADHD story which all started when someone very close to me was diagnosed a couple of years ago. hearing their story got me thinking about my own life experience through an ADHD lens. I recorded the ADHD episode and have an excuse me had a couple of clients whose challenges I could relate to more than just a little bit of a coincidence. Dr. Sherrie All, the star of the Focus Forward episode 16 all about memory connected me with Dr. Jan Willer, a licensed clinical psychologist who lives in Chicago, and she has written two books for practitioners - Could It Be Adult ADHD?, and The Beginning Psychotherapist's Companion, I thought Jan would be a great person to talk with. Jan and I recorded twice, once back in January and the second time just last month in September. The first time we talked about ADHD and what it is, and then spent a while talking about my own experience and symptoms. In September, we met again to reconnect and talk about the post diagnosis experience, and how people can both support themselves or the people they love who have ADHD. So today's episode is all about ADHD. And because it's ADHD Awareness Month, I hope my story helps someone out there find the confidence to go get tested. As you'll hear it has been a positive and life changing experience for me. So first up is our conversation from January. Hannah Choi 02:20Hi, Jan, thank you so much for joining me on focus forward.Jan Willer, PhD 02:25I am really excited to be here. Thank you for inviting me.Hannah Choi 02:29This is take two right? We tried last week but my, I'm a migraine person and my migraines got in the way. So I'm glad we're able to do this today. Glad I migraine free today. Yeah, so we are going to talk about ADHD in adults and what that experience is like for people and how they got there. And so can you share a little bit with our listeners about why about why I'm talking to you about ADHD?Jan Willer, PhD 03:03Sure, yeah, I'm happy to talk about that. Well, I've been interested in ADHD for a good while. And actually a number of years ago, a psychiatrist that I would refer to would start referring adult ADHD clients, to me just kind of out of nowhere. And at that point in time, I didn't know very much about ADHD in adults. And just as a little sidebar, graduate schools usually don't teach very much about adult ADHD. And so every mental health professional out there who knows much about it has taught themselves and gone to seminars and that type of thing. But anyway, so I started teaching myself about it. And the more I learned, the more interested I became, and, you know, it's just a population of folks who really are undertreated a lot of the time and a little education and a little help with executive functioning issues can go and maybe a little bit of medication can really go a very long way in terms of helping people feel better and feel like they're functioning better as well.Hannah Choi 04:16I see that in the clients, the adult clients that I've worked with, where they have experienced exactly that with a little bit of medication, a little bit executive function, coaching, and just like a lot of knowledge, it's really made some big differences. What are what brings someone what are the questions that people have when they come to say, like, I think I might have ADHD?Jan Willer, PhD 04:41Well, a lot of the time, people will come to me and they've already been wondering about whether they have ADHD for a long time. And many people who've had ADHD their entire lives, were not diagnosed as children. And it used you know, back in the old days, it used to be thought that if it wasn't really obvious as a child, and the child wasn't pretty impaired from ADHD, then a person who is an adult couldn't possibly have ADHD. Now we know now that that's not true, because there's a lot of folks who don't get diagnosed for various reasons. Maybe because they just had inattentive type ADHD, and they were well behaved kids. And so, and they were, you know, pretty smart, and they just kind of flew under the radar and their grades weren't amazing, but they weren't disrupting the class, and they were just kind of daydreaming. And, you know, nobody really noticed that they were having some learning issues. So a lot of the time, those are the folks that kind of end up coming to us. But also, sometimes people may have had some hyperactivity as a kid, but their parents, and their schools really recognize that they need a lot of exercise. And so they would get put into sports and all kinds of camps that gave him plenty of exercise and this, so they coped, okay. And they didn't have behavior issues. So, you know, in the past, most of the folks with ADHD who are identified as children were people who had behavior issues, and usually white boys as well. But now we realize that anybody could have ADHD. And, and I think that is that information has gotten out into the popular consciousness. And so people are soaking that up and going, Oh, wow, maybe I have that. That sounds kind of like me. I just thought it was a flaw I had, but maybe I have ADHD.Hannah Choi 06:46So something that I've noticed, just in my observations of people talking about, if they have ADHD, or if they wonder if they do, I have noticed. And I think that there is a stigma around around it around being diagnosed with it and around having those challenges. Do you see that in the people that come to you do, do they express those hesitations?Jan Willer, PhD 07:16You know, I think it varies a lot by the age of the person. Because it seems like, you know, young adults have are much more knowledgeable about people who are neurodivergent, and often seem to have a lot less stigma about that, you know, they understand that people is some people have ADHD, some people are autistic, it's, you know, it's not necessarily such a big deal to them. It's just more a recognition of individual differences. But for people who are, you know, middle aged and older, for sure, and possibly also younger than that, it kind of depends on you know, the environment the person grew up in, they're often did grow up at a time where there was a lot of stigma about having ADHD. And there were a lot of stereotypes about people who had ADHD, which were often wrong. And there may not have even been an understanding that ADHD lasted to adulthood. And so they've often just internalized a lot of shame about some of their life challenges that are very, like completely related to ADHD.Hannah Choi 08:30Can you just talk a little bit about what ADHD is for any listeners who might just kind of have like a surface knowledge of it? And maybe we can help any listeners who might be questioning whether they they might and then maybe some, maybe you could share like some symptoms or some characteristics that aren't necessarily fully known? I mean, that the name of it ADHD, like is Attention Deficit Hyperactive disorder, but like you said before, many people can have ADHD but be the inattentive type. So maybe just share a little bit about what it is.Jan Willer, PhD 09:09Sure, absolutely. Yeah. I mean, the first type of symptom of ADHD that was really recognized was the hyperactivity. And you know, if you've ever seen a hyperactive kid, that's pretty obvious. I mean, that's a kid that's just bouncing off the walls full of energies, maybe really talkative. And so, and then over time, it became clear that a lot of those kids also had some challenges with paying attention, despite, you know, in addition to their high energy level and tendency to bounce off the walls, and then it became clear that there are kids who had the inattentiveness alone. They didn't have the hyperactivity, but they still had a hard time paying attention consistently, especially in school and that was kind of where it was the most obvious but, you know, sometimes that home to their parents would say do this or that and they just kind of lose track of it didn't really absorb that information, or procrastinated, which can be a symptom of ADHD too. And then, you know, as things went along, people started to recognize that for most people, they do not grow out of ADHD. Most ADHD does last to adulthood, not every single one. But most, for sure. And as they recognize that ADHD, lastly to adulthood, they would see that adults with ADHD had a lot of executive functioning problems. And I'm sure that your listeners have a good understanding by now of what executive functioning. So I'm not gonna go into detail about that, because I'm sure you've covered that in a lot of different podcasts. Yeah. And the they actually, many experts actually consider the executive functioning problems to be more disabling for people who have ADHD as adults than either inattention or hyperactivity. Yeah. And we'll see that too. Sure. And when you look back at people who have ADHD as adults, it turns out that the executive functioning problems are a lifelong problem. They're just less obvious in kids, because with kids, the adults in their lives, be it their teachers and parents, you know, other other adults will structure their lives for them. And so they don't have to do as much executive functioning as an adult. That's right. And often, when people who have ADHD go off to college or leave home for the first time, they may, they often do have a lot of struggles initially, because they're not used to doing their own structuring for themselves.Hannah Choi 12:02Yeah, absolutely. I see. And most of my clients are college kids. And that's exactly what I see. Every pretty much in every every client, like, Wow, a lot of things were structured for me in high school. And I thought that I could, you know, just keep up doing the same thing once I got to college and wait a second. Not exactly working out as I thought it would. Jan Willer, PhD 12:24Yeah, and things can really fall apart pretty fast. Because nobody's telling them to get up. And people who have ADHD have a tendency to be night owls. And so, and especially, and sometimes it's so extreme that they could even get a diagnosis of delayed sleep phase disorder, which is a sleep disorder. And so that difficulty getting up to go to things, stay up till three in the morning, hanging out with friends playing video games, whatever, you know, and then they don't want to get up until 11. And class was it 9:30? Yeah, yeah. So there's can be a lot of different pieces to the difficulties that college students can have.Hannah Choi 13:07I know a big part of ADHD for kids and adults. But maybe we can talk about adults here is the self regulation and emotional regulation. How, how does that show up? What do you see in your practice?Jan Willer, PhD 13:23Yeah, I mean, that is indeed a common problem. And about half of people who have ADHD as adults do have this emotional dysregulation problem. And what it consists of is, when people have something stressful, occur, they tend to be especially reacted to that. And it could be just kind of ordinary stuff, like somebody cutting you off in traffic, or it could be something bigger, like, you know, some family crisis or something, or, you know, just a minor change, like, you know, they were looking for peppers in the refrigerator, and they didn't have any, and they were going to, that was going to be a key part of what they're going to make for dinner. And so these stressors, whether they're big or even little, can lead to some pretty intense emotional reactions for the person and the person can feel irritated and frustrated and aggravated. And, you know, depending on the individual, some people have kind of learned to hold all that in because they've realized that other people don't react well, when they're next to somebody who's really, you know, having an outburst about a minor stressor, but other people don't have the, you know, ability, at least in that moment to hold that in and may have, you know, a verbal outburst or a temper outburst or something in response. And that can be, you know, really challenging for the person because they look around at everybody else and they're like, wait a minute, these other people are having stressors to, but I'm reacting somewhat differently from them. And again, this is sometimes where there's shame or embarrassment. Because the person then feels bad about themselves for having a strong emotional reaction when other people might not. Yeah. But unfortunately, it can be a part of their ADHD struggle.Hannah Choi 15:22That's so interesting. I didn't ever know that, that that how closely connected that was to ADHD?Jan Willer, PhD 15:29Yeah, it really should be a symptom that is in the official diagnostic manual, but it's not.Hannah Choi 15:36What are some other symptoms that people might not know about?Jan Willer, PhD 15:40You know, that's a really good question. One symptom that I actually see all the time, is that often people who have ADHD have a really hard time getting to sleep. And they lie down in bed, and they're ready to go to sleep. And their brain just starts going and going and going. And it's very active. You know, folks who don't have ADHD, when they lie down and go to sleep, their brain is kind of like slowing down and not very full of stuff. As long as they're not stressed or anxious about something, yeah. But a person who has ADHD, their brain just tends to be at very active all the time. And that's not true for everybody. But it's true for a very large proportion of people who have ADHD and, and their brains activity will keep them awake. And they may stay awake for an hour when they're trying to go to sleep with their brain just churning over all kinds of different stuff. The default mode network is a network that so the brain has many different networks of connectivity. And the default mode network is one of those. And they call it that because they people used to think that if you weren't doing something, then your brain wasn't thinking about anything. Now, anyone who has tried to meditate knows that that's ridiculous. Yes. Because of you not doing anything, which is what meditation is, to some extent about your brain is full of ideas. And yeah. So so that's the default mode network kind of churning up ideas and thoughts about your life and how we what's just going on with you what you plan on doing just any old random thoughts about your life. And that area does tend to be extra active and people who have ADHD, which is I like you're pointing out the connection to the sleep onset problem. Yeah, right. Also, that area is supposed to be kind of quieted down, when you're working on a task, that since that area tends to be extra active, and people who have ADHD, often one piece of their challenges with distractibility is that they are distracted by their own thoughts when they're trying to work on things. Right. And so they're really trying to focus that their own thoughts are interrupting their thought process. And a final thing that is probably related to the default mode network in ADHD is that people who, there's a little bit of research, unfortunately, there is really isn't enough research on the positive aspects of ADHD. But there is a little bit of research indicating that people who have ADHD tend to be more creative than the average person, and tend to be really great at brainstorming and thinking up lots of ideas. Hannah Choi 18:41I was reading about that. And, and the article was saying that it may be because they're able to not gonna remember the whole brain part of it, but they're able to make connections that might not necessarily be able to be made by someone as easily if they don't have ADHD. Jan Willer, PhD 19:03Yeah, absolutely. Sort of. Yeah, that thinks ability in that part of the creativity of the ADHD brain for sure. Yeah.Hannah Choi 19:10Yeah. Huh. It's interesting that if there's one thing that you said was like, not everybody experiences that not being able to fall asleep bit. So what do you think? When when, like, not everyone with ADHD has all the same symptoms? And like, why do you know why that is? And no, it's just probably because we're just all different. But it's so interesting that some people can quiet their default mode network and then others can't. Jan Willer, PhD 19:41Yeah, it is kind of fascinating, isn't it? Yeah. I mean, I think that part of that has to do with the fact that ADHD, there's no one gene that ADHD is carried on right there. There's a lot of research about genetics and ADHD and a lot of it on us Sleep is way too technical for me. But yeah, I can read enough of it understand that there are dozens of genes at least that affect whether a person has ADHD. Okay, and if so to help what degree? Yeah, because some people have a lot of ADHD, some people have a little bit and some people have none. So, right. Right. And that, you know, plus everybody has a different life that they've been through was raised a different way. And so, you know, sometimes I see people with, you know, pretty significant ADHD symptoms, but they have no problem keeping track of their calendar, because they've had folks working with them their whole life about how important that is. And they've really got the skills down.Hannah Choi 20:43Right. Yeah, I imagine, like so much of your about of how your ADHD affects you, as an adult, is decided by just the strategies and the skills that you've learned and the awareness that you have of yourself and the impact that your behaviors have on your life and on others. And with kids. It's harder for them because they they haven't learned to that. Yeah, they just haven't been around long enough to, to kind of know that sort of stuff.Jan Willer, PhD 21:19Yeah, exactly. And, you know, with my client, adult clients, I don't work with kids. I tell them that one advantage that they're bringing to working with their ADHD is maturity. Yeah. Right. Because having that insight into how some of these challenges of ADHD have affected their life negatively, provides a lot of motivation to work on.Hannah Choi 21:45I interviewed Nancy Armstrong, who was the executive producer on a documentary called "The Disruptor"s and, and that her documentary, really highlights, it definitely explores the challenges. And it also highlights the positive side of ADHD. And that's and their work. Yeah, it's, it's a great, it's a great watch. They're working really hard to dispel a lot of the myths around ADHD and, and help people find the positives. So in your opinion, what are some of the positives? Jan Willer, PhD 22:19Well, we've already mentioned a lot of them, right? The artistic creativity can be one of them, out of the box, thinking of being more of a divergent thinker who's able to connect a lot of different things. I think that because of people having that out of the box thinking, they're often really valuable team members. And, you know, I personally have, of course, I have no proof of this. But my personal belief is that the reason that the genes for ADHD survive in the population is because it's so helpful in any group of people to have somebody who is really creative and full of all kinds of ideas and thinks about things in a really different way. And, you know, to some extent, that might be true of autism as well.Hannah Choi 23:12So it's really interesting talking with you. And I know, it was a conversation that we had the other day before we came on, and in all the research that I've been doing, and all the clients that I've worked with, I'm realizing the more and more I read and the more and more I talk with people that I really think that I probably have our head like had as a child and still have the inattentive type. So much of, of what I've read, and just things that people have said, I'm like, Oh, my God, that just, I feel validated when I hear that and so it makes me wonder, you know, maybe that was something that I could have gotten help with as a child and, and, and can still now like as an adult, find things that helped me. I'm sure that you've heard a lot of people come into your practice and say something similar. Jan Willer, PhD 24:12Absolutely.Hannah Choi 24:17Okay, so in the interest of time, and potentially embarrassing myself more than I'm comfortable with. I'm going to stop the recording of a conversation here. Right after this. I asked Jan, if she'd be open to talking with me about my own challenges. We talked for a while about my life and what I struggle with and why I think I might have ADHD. It was pretty eye opening and extremely validating. She encouraged me to get a formal diagnosis from someone in my state. After chatting with Jan, I set up an appointment with my primary care physician who is an internal medicine doctor. I was really optimistic on the appointment day but things didn't go as planned. I was reminded of something that Dr. Theresa Cerulli said about how internists will not usually entertain a conversation about ADHD, and will generally refer you to a psychiatrist, which is exactly what mine did. Feeling deflated because I knew a psychiatrists fee would be greater than what I could afford. I remembered my own advice to clients. What would this look like if it were easy? So I reached out to Jan again, for more guidance. Do I need to see a psychiatrist is a full neuro Psych Exam necessary? And who else can I consult besides my doctor? Jan assured me that a full neuropsych exam wasn't required. She explained that due to the shortage of psychiatrists available for ADHD support, other providers can diagnose it without a formal neuropsych exam. And this boosted my confidence to search further. And then I found a local psychiatric nurse practitioner online through psychologytoday.com, which is a great resource for that kind of stuff. We met for over an hour, she asked me all about my health history and my childhood, my college years and my coloring challenges. And we went through the adult ADHD Self-Report scale together, which was hilarious. I kept bursting out laughing at many of the questions because it was me but on paper, and I kept wondering "Was the person who created the scale living in my brain?" Initially, I wasn't sure I wanted to use medication. But after learning about the ADHD brain and how it works, I was more open to it. I remembered something else that Dr. Cerulli said, at least have the conversation about medication options. Whether you use them or not, is up to you but have that conversation. I also felt confident trying medication because I already did all the things you're supposed to do, right? I eat well, I get a lot of exercise, my sleep habits are good. I had created systems that work really well to support myself in EF areas that I struggle with. But honestly, I was exhausted, forcing myself to use them all the time and not being as successful as I probably should have. And honestly, I was being pretty mean to myself inside when I struggled. So something had to change. So I decided to try using ADHD medication. I knew I wasn't interested in stimulants because I wasn't sure how they'd work with the anxiety that I already dealt with. And considering my history, Sophia prescribed the non stimulant Wellbutrin initially, it actually worked really well. But unfortunately, it increased the number of migraines I was having. And interestingly, there is a connection between migraines and people with ADHD. And I'm actually having an appointment with a with a neurologist coming up. And I want to ask more about that and learn more about that connection. So anyway, I switched to another non stimulant called Strattera. And that's actually been working great. It's made a huge difference in reducing the constant chatter in my head until it quieted down in there, I seriously had no idea how much noise I had in my brain all the time. I've also noticed that it's so much easier for me to get started on my work and get back to it if I get interrupted. And I can also stay focused on my work for longer periods of time. And following through on stuff that I don't want to do is not so painfully difficult anymore. And I remember Bob Shae telling me that his meds make it easier to use all the tools he had already implemented. I agree, Bob, I completely agree. I have spent a lot of time reflecting you know, me, I love that self reflection and thinking back to choices that I made and things that I did that were likely because of ADHD. I've been reading and listening to podcasts and talking with people about their ADHD. And I am learning so much. I decided to reach out to Jan again to talk with her about what comes up for people once they've been diagnosed, and what supports will help. We met just recently to record and realize it had been almost nine months since we first talked. Let's check in to hear what we talked about. Hannah Choi 29:17So when we last talked, I asked you about my own experience with ADHD and I really am grateful to you for taking that time with me to walk me through that a little bit uncomfortable, and a little scary conversation and and it's just such a great example of this idea that when we step outside of our comfort zone we end up finding magic and and discovering things that we never knew or we knew about ourselves but we didn't like have words for it. And it's just been who I got chills it's really actually been life changing and I'm I am so grateful for it. So thank you.Jan Willer, PhD 30:03Oh, you're welcome. Absolutely. Yeah. Yeah. I mean, I, you know, I do find that a lot of people really appreciate knowing that they have ADHD. Because it has so much explanatory power for what people have been struggling with. And like you said, sometimes people don't even have the words, yeah, for all of their struggles. So being able to talk about it with a professional and have that person say, Oh, well, people who have ADHD often struggle with this, and this and this and kind of give, give the person the words and the ways to conceptualize it. And then they'll be like, Yes, I do that. And yes, I have that problem, too. And yes, that's so hard for me, really can kind of make a difference in terms of the person understanding themselves, and being able to communicate with their loved ones. And people they work with even the whether they come out about having ADHD or not, they can still say things like, it really doesn't work very well, for me to have a lot of interruptions when I'm trying to work on a project.Hannah Choi 31:13Yes, yeah. Yeah, that's a that's a great point that you brought up. And something I wanted to talk about is that whole, you know, disclosing at work type of thing, because so I, you know, I'm very lucky, I work in a job where, you know, I wasn't even an issue for me to disclose, they were just like, okay, yeah, that's great. What's next, you know, and then, and, in fact, it, it probably really helps me as a coach to know and to relate with my clients even more. And, and so I'm very lucky that I work in an environment that is not only extremely accepting of neurodivergence, but also we are in like, the literal business of supporting people who are neurodivergent. And then you know, there's there's other people who may or may not feel safe disclosing that at work. And so I really love that, that that suggestion that you gave just then of how you can disclose your needs without necessarily disclosing your diagnosis. How do you support client, your clients who come to with that struggle?Jan Willer, PhD 32:26Yeah, well, you know, everybody who has ADHD is a little bit different. And so you know, depends on some people work better at home, some people work better in the office, it kind of each person has different situations where they concentrate better. Sometimes that people do better in the office that also certain areas of office are too noisy or distracting. And so they need some help with that. On occasion, I have written accommodation letters for people. And it doesn't always work 100%. But usually, they are able to do something that's helpful to the person. Like I had someone I was talking to once whose cube was right by the coffee machine. And you can imagine how distracting that would be for anybody, much less a person who has ADHD, and they were able to get moved to an area that was a lot quieter. And that made all the difference in terms of being able to be efficient at work. Hannah Choi 33:29Yeah, and I imagine a big part of it is self efficacy and being brave enough to speak up about it. So having someone like you to maybe work through a script, or just kind of talk out what an accommodation might be helpful. I'm, I'm sure that is a big, a big part of people's experience.Jan Willer, PhD 33:50Right. And, you know, people can kind of take two different approaches to that. I mean, one is kind of the official HR approach, you know, going in, I want reasonable accommodations for my ADHD, which legally is considered a disability even though you know, people can discuss whether they could consider it that way or not. And so that's one approach. And the other approach is to say, okay, to think about, well, how is my ADHD interacting negatively with the work environment? And how can I verbalize what my needs are? If I don't feel comfortable or the HR situation isn't optimal in a way that people can hear it and might be willing to work with me on it? Tomorrow, kind of informal approach.Hannah Choi 34:42And I bet when you have an like, I imagined maybe like before someone gets a diagnosis, they still are aware of what their challenges are. Maybe after they get the formal diagnosis. They're like, okay, that might give them some confidence to to ask for what they need there. There's an actual reason why they need that. It's not just that they're bad. They're, you know, there's a real reason. Jan Willer, PhD 35:08Right, and I think you're bringing up a really important point is that a lot of people, you know, like yourself managed to kind of fly under the radar their whole life. And they knew something was going on, they knew they were somewhat different from everybody else. But it often tends to be very internalized. And the person tends to feel like, well, I'm struggling, and all these other people aren't struggling, therefore, there's something wrong with me. And so that, you know, that, then they just kind of end up what caught doing what many people call masking, which is trying to pretend that there isn't an issue, even if they are struggling, and a lot of people can be very successful at pretending. But even though even though inside they're really feeling kind of miserable about Hannah Choi 35:59Yeah, there's a there's a, an internal cost. That is it's maybe not visible, but they are feeling it. Exactly, yeah. Yeah. That That reminds me of, we recently did a webinar about ADHD, and about for people who were newly diagnosed and are curious. And a parent asked about their child who was, I can't remember, I think he was like, older teen young adult kind of college age. So the parents said, he had just been diagnosed, and was feeling like it was a negative thing. And, and, and she was wondering how we could or how she could support him to learn about about it, and maybe see it in a more positive light. And it just made me think like, he's probably spent a lot of his life internalizing all of those things, then you find out, Oh, there's a reason for it. Oh, then this must be a bad thing. So how do you support people who are how can we even our listeners, if we have people, you know, loved ones in our lives? who have been diagnosed? How can we support them? In seeing that it's not all bad?Jan Willer, PhD 37:21Yeah, I think there's a couple of ways to look at this. I mean, one way to look at it is to say, well, you know, if you if you think about it from a disability perspective, which is, you know, one angle to look at things is to say, Okay, well, it's a disability that makes it difficult for this person to learn, in certain situations difficult for the person to work in certain situations take information in and at times, you know, all kinds of other challenges that can come up with that. But does that, does that have to be viewed in a negative and judgmental way? Right, you know, the brain is an organ to the brain, you know, can have issues just like any other organ can have issues. And so, in a way, that's one way of conceptualizing ADHD and thinking about it in terms of not having stigma towards a person who has an illness or a disability or something like that, because nobody deserves that, that's, you know, that's ableism. And that's wrong. So, another way of thinking about it, which I think is is equally valid, is thinking about it in terms of being neurotypical versus neurodivergent. And so, you know, when we think of people who are neurotypical, we're typically talking about a person who doesn't have ADHD, and a person who doesn't have autism. And so, those folks at you know, the world is built around people who are neurotypical is not built to accommodate people who are neurodivergent. And so that's part of the difficulty that people who are neurodivergent have is that it's just not, it's not built for how their brain operates, nothing is built for how their brain offers and the things that are valued, don't tend to be the things that the people who are neurodivergent have to offer. So for example, some of the things that a person who's neurodivergent have to offer our, the, their incredible ability to be really interested and passionate about things and just really dig in and get into something and understand all the incredible connections between they're taught that topic that they're into and everything around it, they're great at understanding things in a network kind of interconnected way. Whereas kind of in this is obviously a little over-simplified, but a person who's neurotypical tends to be more of a linear thinker, whereas a person who has ADHD tends to be more of a, you know, kind of a divergent, tangential type thinker. And also people who have ADHD are often very creative in some way or another, you know, they can be creative in terms of problem solving, coming up with ideas, brainstorming, they also can be very creative in terms of the arts. So, and they're just great at coming up with ideas that no one else ever thought of, you know, and those are not things that the school system was really searching for. Hannah Choi 40:45So help, helping somebody with ADHD who maybe has recently been diagnosed recognize that ability that they have, and recognize how they can use that in a work situation or school situation. Yeah, while simultaneously advocating for themselves to somehow fit successfully into that neurotypical system.Jan Willer, PhD 41:11Right, the neurotypical world. Yeah,Hannah Choi 41:14Yeah. Yeah. Yeah, that broke my heart that he that that boy felt that way. Because, and maybe it's just age, right. So I, I found out that I was, you know, I got the answer to all of my questions when I was 46. And so I, I might, you know, I'm just like, just have more life experience, and I'm more mature, I guess. Right. So I was able to, like, kind of go back and, and hug the 20 year old version of me that, you know, didn't understand. And he is that 20 year old version of himself. And so he doesn't, he just has what other people are telling him. So I guess that's not really sure where I'm going with this, but I like, but it just makes me think of when you've been diagnosed, finding people who really support you recognizing your strengths. And, you know, and following your strengths, following your talents, finding a work environment, or a school environment that is willing and open to supporting you as an neurodivergent thinker. With an ADHD brain or an ASD brain, then, you know, that that would I imagine just lead to a better experience, like I'm having, you know, the fact that the work that I do is very well suited for me.Jan Willer, PhD 42:37Yeah, and I think people who have ADHD are especially well suited to professions where there's always something new to learn, there's always a problem to solve. There's always a new person to talk to, you know, and that, and they're really great at engaging in all of those new things that are coming at them and love, usually love learning new things. Yeah. Which I think is really cool.Hannah Choi 43:05It is. Yeah. Yep. Yeah. And so I was just listening to Ned Hallowell he was on, on a podcast that I really enjoyed listening to with a woman called Kate, I can't remember her last name, but she's a British woman who has a podcast called the ADHD, women's well being podcast, and she interviewed him on there, and he was talking about, and I'm sure he's talked about this and other things, I just happen to hear it on there. But he was talking about how important it is for people with ADHD to, to, to do things that, that they're really interested in and find a job that they are good at, because it's something that they're good at, or because it's something that they're interested in. And to break free from these, like, preconceived notions that society has, like, oh, you need to become this or that or maybe your parents expectation or, or your social circle or whatever. And, and this just another chance, another op op, another situation where a person has to say like, Hey, I might not do things the same as everybody else. Jan Willer, PhD 44:12Absolutely. Right. And doing things different in a different way. Doesn't mean you're doing things in a worse way. Hmm, I like that. Right? Different isn't?Hannah Choi 44:21It's just yeah, it's just different. Yeah, I like that. Yeah. Jan Willer, PhD 44:27And, you know, often I'll tell my clients who have ADHD that it's important to work with it rather than against. Yeah, don't fight it and feel like I have to do everything the way exactly the way that a neurotypical person does it or I'm not successful. Yeah, do it in a way that works for you and your own particular brain. And that's great.Hannah Choi 44:52Yeah, just I have a friend who has ADHD and so we've just been talking a lot lately and, and we were talking about how Oh, how it's so fun talking with another person who has ADHD because you can get really tangental and tangential and come right back and other person just follow right along. I had a client this morning, she's like, sorry, I'm all over the place. I'm like, Don't worry, I, I gotcha. Gotta take a lot of notes as you're going, because otherwise I'll forget what you say. But, uh, mowing you? Yeah. And I guess that deer? Do do you see in your clients desire to connect with other people who have ADHD or to find a social support that way?Jan Willer, PhD 45:39You know, I think it's interesting that you're bringing that up, because I have certainly have noticed that a lot of my clients who have ADHD do tend to have friends who have ADHD, and sometimes even spouses, but the spouses can go either way, sometimes they have ADHD, and sometimes they want to be with somebody who's very organized. Like, they want to be with a really neurotypical person, balance them out. Yeah, exactly. But they do tend to really, you know, kind of enjoy that bouncing around. Yeah, seasonally, that happens when two people have ADHD. It's an interesting phenomena. Hannah Choi 46:18It's fun! We're fun people. Jan Willer, PhD 46:20Yeah, I mean, people who have ADHD tend to be full of life. And, you know, it's really and spontaneous and have lots of interesting things to say. And you know, that's cool. That's a good friend.Hannah Choi 46:35Something that, that I've been thinking about lately is the anxiety that comes along with ADHD and how, for me, realizing how connected they were was so freeing, and it's truly incredible how much less anxiety I am experiencing now. And I remember you said that you said to, you often encourage people to explore the ADHD diagnosis when they have it, where they have anxiety. And at night, I really can speak to that it made a really big difference for me. And then I think back to my childhood. And I remember I went to the summer camp, and they gave away awards at the end of the summer. And the award that I got, which I was 12. And now looking back on it, oh god that my poor 12 year old self, the worst they gave me was the "What If Award". And because I always used to say, well, what if what if this happens? What if that happens? I was really anxious. And it nobody said like, "Wait a second? Why is she wondering all the time What if?" And now I realize it's because my brain was thinking of all the things, all the things. And I just so when I realized that I was in the car today while I was driving. Oh, so I went back to my 12 year old self. It's okay. We get it now. Yeah, so that's been that's been like a really nice experience that I've had is being able to go back and just kind of forgive myself a little bit.Jan Willer, PhD 48:09Yeah, yeah, it really it does take a while to kind of turn over all the things that happened that were related to the ADHD, and put it all in context, isn't it?Hannah Choi 48:20Yeah. And it's, yeah, it's and you know, so it's been, like, nine months since we talked, so nine months of me, like really exploring that. And, and it's, I think, out of the whole experience, I think that is probably the most impactful is being able to explain a lot of things and, and really forgive myself, because I held on for so long, that, that I was just bad at all those things, and, and internalized so much of it, and I and I, but I was really good at masking it even to myself. And so it's just been, like incredible, but for sure need a therapist. Like, I don't think I would have been able to do that all on my own. I wouldn't, I would have been more afraid to go there without the support of a therapist, you know, like, walking me through it is it's been. It's been hard. And it's been amazing. Yeah.Jan Willer, PhD 49:27Yeah. So there's there's a lot of advantages that can come to having a therapist who is knowledgeable about ADHD, right? Yeah. Because they can help you sort through those issues from the past and get their perspective on it. Right. And they can provide you with a lot of information about ADHD and you know how the brain works when a person has ADHD. Yeah, what their common struggles are or what their differences are. So, so that's, that's really useful too, and it can help you work on and coping skills if there's things that you're struggling with. Hannah Choi 50:03Yeah. So you know what, before we go, what kind of it? Like, what's your top advice that you give to people? Right? You know, when they, when they come to this realization like, oh, okay, this is why?Jan Willer, PhD 50:19Well, I think it's the case with any, you know, cognitive or emotional difference that a person may have in that get, you know, knowledge is power, right? Yeah. And so the more a person understands themselves, the more they understand how their brain is working, the more they've understand how ADHD has affected their life, and affected how they feel about themselves and their emotions, you know, then that really helps them figure out how to move forward. Yeah,Hannah Choi 50:53Yeah. And that might take a while and might take a lot of hard work. Probably some tears. Yeah. All right. Well, thanks again, Jan. I will be forever, eternally grateful to you for taking the time and for being so supportive. And I really hope that anyone listening can can find a Jan Willer in their lives, to you know, to kind of walk them through this whole, like, exploration of possible ADHD diagnosis. Hannah Choi 51:33I just like I like you heard me just say, I am just so grateful for this diagnosis now at age 46. And I'm sad that there was not as much education and understanding about ADHD back when I was a kid so that me and other people like me, could have gotten help earlier. And mom, I know you're listening, I just want you to know that I placed absolutely no blame at all on you, or dad, or on my teachers or the other adults in my childhood, there just wasn't the knowledge, the awareness and understanding that we have today. And I know there are people out there many of them women like me, who were masking their symptoms with coping skills, they were not so that were not so outwardly noticeable to others and didn't have any catastrophic consequences. But they were slowly turning them us inside into people who struggle to find confidence, and believe in themselves. So I am really hopeful for myself and everyone else out there who can relate to any of what I've shared today. If you can relate, please reach out, ask for help ask the questions. It's scary, but you got to do it. I made an appointment, like I said before with a neurologist to learn about my migraines and the connection with ADHD. And I also made an appointment with a more affordable psychiatrist who does full neuro psych reports for less than the typical cost. I'm very excited about that. And you know, as Jan said, knowledge is power. So I'm taking my brain health into my own hands and learning as much as I can. And I really hope that you're able to do that for yourself as well. Hannah Choi 53:11If you've been listening for a while, you'll know that one of our main goals is to hopefully help someone somewhere who is struggling with an aspect or maybe many aspects of their executive function skills. Well, this episode is here to maybe help that person find freedom from their frustrating past. By finding the courage to get tested, ask questions, learn about medication and strategies that truly can make a huge difference. It was hard and kind of weird to put myself out there for this episode. My colleagues and Jan both asked me if I was okay with being in that vulnerable position. But I thought about all the people who might be able to relate who might not know where to start and who might find some inspiration and maybe some bravery in my story. I also figured if Katie Couric, Jimmy Kimmel, and Ryan Reynolds can all share their colonoscopy experiences on TV, I can share my ADHD story with you on Focus Forward. Hannah Choi 54:10And that is our show for today. If you know anyone who might want to hear all this or maybe needs to hear all this, please share this episode with them. You can reach out to me at podcast at beyond booksmart.com I would love love, love to hear from you. Please subscribe to focus forward on Apple and Google podcasts, Spotify, or wherever else you get your podcasts and if you listen on Apple podcasts or on Spotify, please give us a boost by giving us a five star rating will love you for it. Sign up for our newsletter at beyond booksmart.com/podcast. We'll let you know when new episodes drop, and we'll share information related to the topic. Thanks for listening everyone.

When our guest Mary suddenly lost two loved ones she opted to seek therapy to talk about her loss. She decided with her doctor to start taking Wellbutrin and grounded herself from flying. When Mary was ready to get back in the left seat she sought out her special issuance medical. Little did she know it would be an ACL surgery from highschool that would hold her up from doing so. After providing the required paperwork and doctors approval she received her 1st Class SI. Listen more to hear about Mary's experience… If you or a loved one is struggling, help is available. Dial 988 for the Suicide and Crisis Lifeline. SOCIAL LINKS- Instagram: https://Instagram.com/thepilotspandemic https://instagram.com/emneonicon https://Instagram.com/thefitaviatrix Link for aeromedical reform petition: https://www.change.org/apilotspandemic WEBSITE: https://msha.ke/thepilotspandemic/ SPONSORS: www.avi-foods.com @avi_foods_co Code:pilotspandemic --- Support this podcast: https://podcasters.spotify.com/pod/show/thepilotspandemic/support

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

Get comfy for my adventure/horror story about EAA Airventure 2023. Then we go over the newest medication approved by the FAA for the treatment of depression.  

“How we treat our guests is as important or more important than the treatments we recommend.” -Dr. Hotze. That's what Jessica experienced when she came to the Hotze Health & Wellness Center all the way from New York! Before she came to the Hotze Health & Wellness Center, Jessica was having low grade fevers and going into early menopause. Her symptoms included allergic reactions, extreme exhaustion (frequent naps), body aches and pains in her joints, tachycardia, poor vision, irritable moods, loss of strength, etc. She saw 8 or 9 different conventional specialists in New York who ran a battery of multiple tests, without resolve. One doctor put her on Wellbutrin for depression, and a marijuana pill to increase her appetite. In her search for answers, Jessica began to search her symptoms on YouTube and came across a video of Dr. Hotze that piqued her interest. She began researching the clinic and has now been a guest since April 2012. In fact, the hope and hospitality at the Hotze Health & Wellness Center encouraged her to move to Houston in 2014! Join Dr. Hotze and his special guest, Jessica Silva as they discuss the natural health alternatives that helped her regain control of her health and her life! The simple solutions that multiple specialists couldn't figure out. Watch now and subscribe to our podcasts at www.HotzePodcast.com. If you have any of the signs and symptoms mentioned on this podcast, take our free symptom checker test at https://www.hotzehwc.com/symptom-checker/. To receive a FREE copy of Dr. Hotze's best-selling book, “Hormones, Health, and Happiness”, call us at 281-698-8698 and mention this podcast. Includes free shipping!

In this Just Chatting episode, Lina discusses her complicated feelings around her ever-changing body. She gained weight after her first pregnancy, then lost the weight, and is now gaining it again with her second pregnancy. Although she feels blessed for her pregnancy, she's not loving the process of gaining weight again. Lina shares about how radically accepting her body changing has helped in navigating the complex feelings around weight gain. Mentioned in this episode:Eating to Get Pregnant and Fertility Myth Busting with Nora Debora, Preconception Health CoachSolo Episode: My Eating Disorder Journey and How It's Affected MotherhoodNuuly Code: http://fbuy.me/ruacV Use my link for $20 off your first month's subscription Content Warning: This episode includes discussions around weight loss and weight gain. If you're sensitive to those topics, please be mindful :) Support the showConnect with Lina on @linaforrestal on InstagramFollow the @newmamaspodcast on InstagramRead Lina's Blog: www.linaforrestal.comSupport the Show: Buy Me a Coffee (https://www.buymeacoffee.com/newmamaspodcast)

Dr. Delia Aldridge, MD, FAPA, CEDS-S   There's not a book for psychiatrists working with eating disorders Doctors must know about refeeding syndrome Helping parent who says “They had a PR yesterday, why do they need to be admitted?” Dr. Aldridge says “If this was my kid, knowing what I know now, I would be scared for their life.” Find people in your community – therapists, dietitians, primary care docs ER –it took 5 years to train and find ER she could trust Co-occurring - Fertility problems, OCD, Anxiety, depression, trauma, Medications – what are pre-existing conditions, two that are FDA approved for eating disorders, Wellbutrin contraindications for pts with ED Vyvanse for BED – make sure full team - CBT and RD on the team (addiction, cardiac issues) Prozac Dr. Aldridge's Seasonings: Dr Mehler's Medical Guidelines APA New guidelines (but it's not much) We need to infuse our brains with food, medical, psych resources Handout on risk of refeeding Here's my cell phone, text me https://www.feast-ed.org/info-for-parents/ Bio: Dr. Delia Aldridge   With your host Beth Harrell IG  @beth.harrell.cedss   Supervision Freebies          

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

In this week's episode the girls discuss Hunter's biggest “cringe” and talk about if men should even be allowed to walk alone in the park. They also catch up on the shows they are binging (and you should too!) and most importantly Michaela gets real and honest about where she stands with her mental health. She talks about the realization that led her to discovering she had to address her mental health in a more serious manner and the steps she is taking to get the help she needs. They also dive into the importance of de-stigmatizing the conversation surrounding mental health, depression, and medication!

EMAILS: Being calmed by our voicemail to pass a driving test. Lucid dreaming. VOICEMAILS: Alberta Jones episode suggestion. Endometriosis is a bitch. A driving instructor who loved Taco Bell. Why do we do anything when it snows? Wellbutrin made a listener hate bananas. Another car curse? Groom being breast fed by mother before wedding. Ali & Maria's sexual tension. Herpes 1 is on the mouth, Herpes 2 is way down south. Webcrawlerspod@gmail.com626-604-6262Discord / Twitter / Instagram / Patreon / MerchSupport this show http://supporter.acast.com/webcrawlers. Hosted on Acast. See acast.com/privacy for more information.