This Is Your Brain On Drugs Psychiatry Podcast

In today's episode I will go over how to dose antipsychotics. I will discuss the difference between the max dose on the package, the max clinical dose, and the dose at which you will get 95% effectiveness, and these are not always the same. I will discuss the effect sizes of these medications as well. Then I will discuss how meals can effect these medications. Some need to be taken with food, some without, some just consistently one way or the other, and some without water. Then I will go over a basic patient education that I would discuss with patients...

Today I will introduce you to the antipsychotics. I will go over the first and second generation antipsychotics. I will discuss their differences. I will go through each one and give details about when it came out and what it is approved for. This will be just an introduction to what we will be talking about in the future in detail but I think you will learn a lot of stuff that you didn't know even in this basic episode.

Today I will continue with some more medical topics. I will discuss the medical causes of psychosis that need to be ruled out, and I will discuss how to do a proper medical work-up both in the emergency room and inpatient psychiatric unit for new onset psychosis. It is extremely important to look for other causes. These are frequently missed. I've seen it a number of times, so I will talk about how not to make those mistakes.

In today's episode I will discuss two common disorders associated with schizophrenia and antipsychotic use: psychogenic polydipsia, a condition where patients feel a compulsion to drink water to the point of medical emergency, and catatonia, a condition that is either extremely slowed or agitated that is often missed in schizophrenia patients. It is important to give patients the correct treatment as not doing so can be life threatening in these conditions. Having psychosis can make it difficult to differentiate these conditions, so it is important to discuss them and consider them.

On today's episode I will discuss the diagnostic symptoms and process for schizophrenia and related disorders. I will go over the symptoms in detail as well as the DSM criteria. I will then explain the hypothesis behind how we think this disorder works in the brain. This will prepare us to understand how the medications work when I explain them in the future.

I am starting a new season today, and I will be talking about antipsychotics. On today's episode I will be going over background information of schizophrenia: epidemiology, etiology, disease course, prognosis, and economic burden.

This is the final episode in the obesity series. I will discuss weight loss procedures such as bariatric surgery and endoscopic procedures. I will then talk about lipedema and how it can cause obesity but should be treated differently. Lastly I will talk a little about fatty liver and a new medication approved for it.

In today's episode I'm going to cover the GLP1 medications on the horizon. These include CagriSema, retatrutide, survodutide, and amycretin. Then I'll compare and contrast the currently approved GLP1s. I'll go over which weight loss medications are approved at which ages for pediatrics. Lastly, I'll go over the hurdles of insurance coverage and give you an example of how the requirements for payment change and what those requirements are.

Today I will be covering the GLP1 medications. Starting with exenatide and dulaglutide and then covering liraglutide (Saxenda), semaglutide (Wegovy), tirzepatide (Zepbound), and orforglipron (Foundayo). I'll go over how they are different, which work better, which are better tolerated, how to customize them, how they compare, and when I would pick each one.

Ok, so last time I discussed some of the downsides of GLP1 medications, and this will be part 2 of those downsides. First, I'll discuss eating disorders. How prescribing GLP1 medications in a world with eating disorders is complicated, and how GLP1 medications can actually induce eating disorders; something call "agonorexia." Then, I'll talk about drug interactions. Most of those listed on the package insert are not terribly important, however there are actually several that no one talks about and many of them apply to use with psychiatric medications! Lastly, I'll talk about cost, frequent shortages, and the world of compound...

Ok, so I've exalted the benefits of GLP1s and last time I went over how to customize to your patient. Today I will be going over some of the downsides. I'll cover the really serious stuff first that actually never happens in some cases or rarely happens in others. Then in the second half I'll go over the stuff that actually happens pretty frequently and bothers patients and how to combat it to customize these medications to get the best out of them for those that need and respond to them!

Today continuing with GLP-1 agonists, I will talk about the subtleties of dosing. It's a lot more than what the drug manufacturers publish. Simply following their simple instructions will not work for most patients, so I will discuss how to personalize. Next I will discuss how long patients will need to take the medications, and what to do when it's time to maintain their weight. Lower the dose? Change to a different med? Change the frequency? All these and more so have a listen and learn how to personalize obesity treatment with these highly effective medications, so that patients have...

Today we finally reach the GLP-1 medications! It's been a long slog through obesity medication, but I feel like this is what everyone has been waiting for. I will start off today by telling you how these medications work on the many parts of the body on which they do work. I will then go through the long list of benefits that they have on these various body systems, and I will back it up with the scientific literature. The benefits are massive and probably even more than you imagined, so have a listen! And don't worry I'll talk about...

Today we will finish up on medications used for weight loss prior to going in to the GLP-1 medications. I will be discussing several medications today. These are medications that you will use less often, but most of them have important roles to play with some patients, so it's important to have them in your arsenal to personalize care. I'll discuss metformin (Glucophage), topiramate (Topamax), orlistat (Xenical), pramlintide (Symlin), Lorcaserin (Belviq), Gelesis100 (Plenity), Setmelanotide (Imcivree), and SGLT2 inhibitors.

Today is the last episode on ADHD, and I will finish off by talking about the effects of estrogen on ADHD symptoms both during the menstrual cycle and perimenopause. I will discuss using hormone replacement therapy as well as changes to ADHD medications to combat these symptoms. I will also discuss comorbid autism, anxiety, depression, and bipolar disorder as well as treating executive functioning which does not respond well to medication.

Today I will continue with weight loss medications, and we will focus on two of the newer options. First the phentermine/topiramate ER combination pill known as Qsymia. Then I will talk about the naltrexone/bupropion combination pill known as Contrave. You may be thinking to yourself, why even bother with these now that GLP1 medications are so effective and everyone is using them? Well, these medications definitely have their place and they are not as straightforward as you may think they are. There is a lot of nuance that you can use in prescribing them, and there are a...

Today we will finish up the medications for ADHD with the remaining non-stimulant medications. There are actually quite a few non-stimulants with more than half being used off label. I will talk about the alpha 2 agonist medications guanfacine and clonidine, which are the FDA approved medications. Then, I will talk about off label options like TCAs and bupropion. Lastly, I will discuss two new medications on the horizon likely to be approved soon, solriamfetol and centanafadine. I will finish with saffron, which is one of the few herbal options which shows some promise.

We have finally finished going over lifestyle factors for obesity and mental health and will start talking about medications. Today I start with medications that you should be considering first line, including phentermine and several others that you are probably less familiar with like diethylpropion, phendimetrazine, and benzphetamine. I will talk about the amphetamines that have been used for weight loss as well as ones like Vyvanse that are currently used. I will also talk about fenfluramine and its connection to phentermine and also sibutrimine which was taken off the market. A lot of interesting history and pharmacology in here...

Today we will be moving from the stimulant medications to the so called non-stimulants. Stimulants include methylphenidate and amphetamine as well as modafinil. There are actually quite a few non-stimulants with more than half being used off label. I will introduce the non-stimulants today and then talk in depth about two of them, atomoxetine, brand name Strattera, and one of the newest psychiatrist medications, viloxazine, brand name Qelbree.

We have finally finished going over lifestyle factors for obesity and mental health, and now if that was not enough to help the patient for weight loss and metabolic factors, we will need to consider using medications, but before we start medications, we need to do a medical assessment. Actually you would do this assessment before lifestyle factors, but I think this is a good time to talk about it right before we talk about obesity medications in the next podcast, so it may not be as exciting of a topic, but we have to screen patients for other causes...

Today I will be wrapping up the lifestyle factors that contribute to health problems like mental health and obesity. I will briefly discuss getting adequate sleep, avoiding toxins like alcohol, tobacco, and drugs, healthy relationships, lifelong learning, and spending time outdoors. I think many of these are overlooked when trying to lose weight or fix mental health problems. Diet and exercise are all over the internet now, but I think these factors are neglected and ignored and doing so may just be the reason why things are getting better, so in that regard, these could actually be the most important...

Today I will wrap up the last episode on adverse effects of stimulant medications used to treat ADHD. I will be discussing the black box warning regarding abuse, misuse, and addiction. This risk is very much overstated, and it leads to providers withholding potentially life changing medication from a lot of patients, so today I will be going over the scientific research on how risky these medications are, when to worry about it, and what to do when actual concern exists, so you won't want to miss this one!

So we had two episodes on the efficacy of antidepressants and I think I may have been a little hard on them, so I decided to make a part 3 where I instill some hope in these medications. They work great for so many people, yet so many people hate them as well. How can that be? And why do their effectiveness numbers look so abysmal? Find out on this episode!

I bet a lot of you have heard of psychogenomic testing or at least seen one. Maybe you are a patient and you got one or are thinking about getting one. Are these things worse the time and money? Listen to this episode to learn about them and get my 2 cents on the topic!

On the last episode on antidepressant efficacy we discussed effect size and placebo. On today's episode I will cover a topic called psychodynamic prescribing. I'll be giving you tips on how to become a prescriber that gets max effect from medications. There's a lot of things that you can to maximize the effect, so tune in to find out what they are.

OK, so we've learned about the antidepressants, how to pick one, and how to dose. Well, how well do they work? I'll be discussing the efficacy of antidepressants on this episode, and I will be exploring the idea of placebo as it relates to these medications. It's more than what you would like, so tune in to find out all about it!

So we've finally gone through the massive topic of nutrition, and today I'll just have this one episode on physical fitness. That's not because it isn't as important, but I think it's just a lot easier. With nutrition there's so much false information out there, but with physical fitness, it's basically just make sure you are moving around and not sedentary, so I will go over the research that ties physical fitness to improved mental health outcomes, I'll go over how much physical fitness you should strive for, and I'll give some tips on things you can do to get...

It's been a few months since my last update episode, and I have several updates in the world of psychiatry. A couple studies of the ketogenic diet for depression and anxiety, a newly approved device for depression, a blood test for Alzheimers, ibogaine in Colorado, pregnancy risk with benzodiazepines and sleep medications like Ambien, a new study on the non-link between Tylenol and autism, and many more. I hope you enjoy these updates of real time information that has come out since November!

Today I will continue talking about potential adverse effects of stimulant medications. Last time I discussed several adverse effects, but today I will mostly be focusing on cardiac (heart) effects because those have gotten a lot of press, especially with a previous black box warning for this. I will also talk about use in pregnancy in this episode. Next time I will discuss substance abuse issues which will round out all of our potential adverse effects.

So today I wanted to do an episode about deception in health information. How do these deceptions work and how to detect them. We don't all have the knowledge or time to go through the literature with a fine toothed comb, and even those like me that do have more knowledge and more time can still be misled, and we are often misled by well intentioned folks that think they have correctly interpreted the data and are revealing some kind of new controversial truth to us. I mean governments and businesses have an incentive to mislead us and have in...

Today I do a deep, deep dive on Adderall, aka Mixed Amphetamine Salts, and I attempt to answer my own questions, "Why are there 4 different salts in Adderall?" I mean I get that there is a mixture of levo and dextro, but why the sulfate, aspartate monohydrate, etc.? Well, for those of you that are wondering this is well, I think I have the answer. This is not stated anywhere that I could find, it is my best guess hypothesis. It's interesting because as far as I am aware, other than Xywav, there is no other medication that is a...

So, we've talked about every stimulant medication for ADHD under the sun and we understand them pretty well. Next, I will be discussing the adverse or side effects of these medications. What are the most common ones? Which should we take more seriously? And what can we do about them when they happen? I'll be discussing how to mitigate these adverse effects so that patients can take their stimulant medication that works for them, while not having to suffer from the side effects at the same time. I will go over most of the major ones today, but I will...

Well, we've gone through all of the information about nutrition. What's healthy. What't not. How to eat better. As well as the scientific evidence for improved nutrition and mental health. Today on the last episode in the series I will be discussing all the stuff that gets in peoples' way when it comes to eating the way that they want to in order to live a healthier life. I have several factors that I will discuss, and I will give strategies for how to address these barriers so that when you face them, you will know what to do about...

Today I will finish talking about the methylphenidate formulation medications. This will be part 3 of 3 of the truckload of methylphenidate medications. I'll discuss the now no longer available Adhansia XR, the dexmethylphenidate products, Focalin and Focalin XR, the newest serdexmethylphenidate + methylphenidate product, Azstarys, and the off-label stimulants, modafinil and armodafinil. Once again I'll talk about how these different from each other and when you should choose one over the other. What are the advantages and disadvantages to each? Well, you've come to the right place. Have a listen!

Well, I've finally made it to the end of my nutrition talks and to round that discussion out, I will be going over the scientific data and evidence for improving your mood through improving your diet. There's actually a fair amount of studies out there, and they are growing. We will go over all that evidence today, so if you've been wondering why I've been talking about nutrition on a psychiatric medication podcast, then this episode will answer that question because diet works better than medications, and I'm going to talk about that evidence today.

It's almost January and I'm releasing Part 2 of my November Updates. Today I'll be discussing several topics. Seltorexant, Ketogenic Diet, and Fecal Transplants for Depression. Consta is generic. Uzedy and Lumateperone have new indications. New drugs that may get approved for ADHD and negative symptoms of schizophrenia. Hyperemesis gravidarum associated with depression. A case of menstrual psychosis. And more.  Lots of good stuff today. Enjoy!

Today I will continue talking about all the methylphenidate formulation medications. This will be part 2 of 3 of the truckload of methylphenidate medications. I'll discuss the patch Daytrana, the long-acting liquid Quillavant XR, the long-acting chewable Quillachew XR, the extra long-acting Aptensio XR, the oral disintegrating tablet Cotempla ODT-XR, and the much delayed release Jornay PM. You may be wondering how are these different from each other and when should I choose one over the other. What are the advantages and disadvantages to each? Well, you've come to the right place. Have a listen!

Today I will be rounding off my information on macro and micronutrients and diet advice, so it's a bit of a hodgepodge. I'll cover cholesterol and protein, and then I'll talk about healthy foods for your brain. These are foods I've been talking about during this whole nutrition section, but I think this gives a good summary of the foods that we have some research on to suggest it is good for mental health.

I'm finally putting out part 1 of my November updates episode. I recorded it a while back but its hard to put out 2 episodes in a week! Today I'll be discussing several topics. New information for you and me on mechanisms of action of vortioxetine, great new data on pramipexole for depression, a new drug on the horizon for schizophrenia? Dangers of Tramadol by itself and in combination with antidepressants, Doxycycline may decrease risk of developing schizophrenia, potential mental health consequences of use of finasteride, the hair loss and enlarged prostate medication, and finally a case series of guanfacine used for...

Today I will start talking about the methylphenidate products. I'll start with the oldest ones, brand names Ritalin, Methylin, Metadate, and Concerta. This includes capsules, tablets, liquids, and the special osmotic capsules used by Concerta. I will mention short acting and long acting versions of Ritalin. I'll compare all these and let you know when I think it might be best to use each one. This will be the first of three episodes covering methylphenidate, as there are quite of few of these to go over. They are basically all the same drug, but the formulations are very different, and...