#43 B Vitamins and Why They Are Important for Mental Health

Today we continue our journey through complementary medicine and its impact on depression. Last time I talked about herbal treatments, and today I will start off a short series on vitamins and minerals. On today's episode I'll briefly talk about vitamins in general and then I'll focus on the B vitamins most important for mental health, B12 and folate. I'll talk about why they are so important, how one could become deficient in them, how to check for that, and what to do about it. Many of your patients are probably taking vitamins and thinking they are helping them, so I think it's critical we know as much about them as possibile so that we can counsel patients and actual prescribe them when they are actually needed!

Quick Take #1: Suzetrigine (Journavx)

Today I'm putting out a special episode that I'm calling a Quick Take where I'm featuring new information that comes out that is not with the topic that I am currently covering. This episode is about a first in class new non-opioid pain medication called suzetrigine. This is an interesting medication and may have potential to replace opioids. On this episode I'll talk about what's known about this medication and what you need to prescribe it. I'll also touch on the idea of using new medications and the cost associated with doing so. This is a little different than what I've been talking about so I hope you enjoy!

#42 Complementary Antidepressants Part 1: Herbal Antidepressant Treatments: St. John's Wort, Rholiola Rosea, and Kanna

Today I'll be starting off my series on complementary depression treatments with herbal treatments. St. John's Wort and Rhodiola Rosea are probably the most well known and most likely to be helpful so I'll be covering the available research on those and give my opinion on their effectiveness. I'll also be talking about Kanna which is a new one that I've recently heard of and tried myself! It has some intriguing mechanisms of action that I'll discuss as well. A lot of your patients may be taking these or may be more interested in taking one of these instead of a pharmaceutical so I think it's important to know about them so you can give the most well informed opinion on them.

#32 Medication Treatment Course: UPDATE on Discontinuation

I touched briefly on discontinuation on this episode, but I found some cool information from RELEASE from the University of Queensland in Australia that have some awesome resources for discontinuing medication. I'll go into more detail on differentiating withdrawal from relapse, when to discontinue, reasons to discontinue, and more details on how to taper. 

#41 Hypogonadis vs Depression

We just had several episodes regarding antidepressant use that are unique to females, so today I will have one that will be unique to males. In this episode I will compare and contrast depression with hypogonadism. You will learn how to differentiate these two disorders which have extremely similar symptoms. I will also teach you how to work someone up appropriately for hypogonadism so that you can rule it out if you are suspicious. It would be silly to send someone to another practitioner to do the work up and then put your evaluation on hold for depression in the meantime, and treating someone with hypogonadism with antidepressants could actually make things worse! So let's learn how to differentiate the two diagnoses, do the work-up, and if you are bold, I will teach you how to treat and monitor hypogonadism as well. Low T has become so popular in society, so why not learn more about it?

#40 Breastfeeding and Antidepressant Safety

Today we have the third and final episode on reproductive psychiatry where I will be discussing relative safety of antidepressants as well as some other psychiatric medications with breastfeeding. I will also go over the relatively new L1-L5 rating system. This is the final episode on reproductive psychiatry for antidepressants, however I will have an installment when I go over each other category of medication in subsequent seasons. I hope you enjoy! 

 

UPDATE!: I actually found out a lot of the L1-L5 ratings have changed. Some of the changes are big, most not. Also, there are a lot of meds that have been given a rating that I previously did not know, so I have added a bonus episode to this one as a separate episode.

#39 Peri-partum Depression

Today we have episode 2 of our reproductive psychiatry series, and I will be talking about peri-partum psychiatric symptoms with a focus on depression. I will discuss all the factors surrounding treating these patients to include the use of medications. I will talk about the relative safety of the different antidepressants during pregnancy and give you my top choices for the safest ones. I will also talk about post-partum depression and two of the newest psychiatric medications which have recently been approved for this condition, Brexanolone (Zulresso) and Zuranolone (Zurzuvae).This is such a critical time in the life of mothers and growing fetuses. It is so important to treat psychiatric symptoms as it can have an impact for the rest of the child's life, so we want to make sure to treat and not treat at the right time and with the right medications. So please have a listen!

#38 Premenstrual Dysphoric Disorder (PMDD) and Peri-menopausal Psychiatric Symptom Treatments

Today I'm going to be talking about something that I've wanted to talk about for a while. Even though I'm a male, I am very interested in reproductive psychiatry. I like to learn about new things and new medications. I want to find out-of-the-box treatments that have scientific backing to treat my patients because guess what, SSRIs don't fix everything! Also, I absolutely hate referring patients to other specialists to receive treatments that I am perfectly capable of handling myself. So, today we will be learning about depressive symptoms centered around the menstrual cycle. We will be learning about birth control pills, estrogen, progestin, testosterone, tamoxifen, bazedoxifen/estrogen (Duavee), and fezolinetant (Veozah) to help with those suffering from PMDD and peri-menopausal symptoms. And the good news is that these treatments are really effective! More so than much of what we have already discussed, and there's nothing I enjoy more than treating someone and them getting a lot better quickly, so tune in to find out more!

#37 Pediatric and Geriatric Psychiatric Drug Management

It's time to talk about the differences in using the medications that we have discussed for depression in kids and seniors. I don't have a subspecialty board certification in these fields but I do know a thing or two about how prescribing to these populations differs from prescribing to adults. My guess is that even if you don't see kids that you probably see a number of seniors. There are different factors to consider when prescribing to these populations, so tune in to find out more!

#36 Depression Subtypes: How to Pick the Best Antidepressant for Each

There are many subtypes of depression, and this can be important when selecting the best medication. Today I will be going over these subtypes and will be giving you the algorithm for each as to what I would pick first, second, third, and so forth. Knowing this may lead to going with an MAOi or TCA, for example, much sooner than you thought you would, which can lead to faster resolution of symptoms for the patient. I'll talk about Treatment-Resistant Depression, Atypical Depression, Melancholic Depression, Anxious Depression (Depression with anxiety distress), Depression with Mixed Features, Psychotic Depression, Seasonal Affective Disorder, and I'll briefly mention catatonia and peri-partum depression which I will go into more detail later. So, if you aren't familiar with all of these and you aren't aware of the differences in med choices for each, you'll definitely want to listen to this episode!

#35 Antidepressant Augmentation

So you've found an antidepressant that seems to be helping the patient, but not quite as much as you'd both like. It's maxed out or we've topped out on adverse effects and can't take it any higher. Should we change it? Maybe not. We can try adding something to it. But what should we add? That's what I'll be talking about today. I'll go over every augmentation strategy that I can think of, and there's a lot of them, and I bet you haven't heard of more than a few of them, so listen in and find out what I think about adding medications to a patient's antidepressant regimen.

#33 Antidepressant Efficacy Part 3: The Case for Antidepressants

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!

#32 Medication Treatment Course

We've gone over all the antidepressants. We've talked about how to pick one. But what do you do when you find the right one? How long should the patient take it? Is it ok to come off? How do you take them off? How likely is it that they will get worse again and how do you respond to that? Well that's what I'll be discussing today, so tune in!