#57 ADHD: Adult ADHD

Today we switch back to ADHD and I will be talking about adult ADHD. I'm an adult psychiatrist and I practiced in the military so this was one of the largest issues that I treated as many of my patients were younger folks, many of which struggled in school prior to joining the military. There isn't a lot of formal education on this topic and yet we see tons of online information of folks talking about how they have adult ADHD and that if you answer these few questions this way then you have adult ADHD, so there's a lot of misinformation out there on this topic. It's a topic that wasn't really discussed at all until the last few decades and many still deny its existence at all. I'm going to talk about it in depth on this episode and I think you will find it very interesting and hopefully different than what you may have heard before. We will dive much deeper than the DSM definition which is mostly designed for children, and I will talk about how someone's life with adult ADHD looks so that you can pick up on the subtleties and make the best diagnosis in order to treat patients with the best care possible. So please have a listen!

Quick Take #3: September Updates! Part 1: Old Drugs For New Indications (Ketamine, Strattera, Flexeril) And Some Antidepressants On The Horizon (Nelivaptan and Seltorexant)

Welcome back to my second episode covering several snippets of breaking news on psychiatric medications. In these episodes I don't deep dive like normal, but instead cover several important breaking news items that affect psychopharmacology and give my quick take on the news. Some of this will be trial results, FDA updates, interesting papers that were recently published, and anything else I can come up with. I have a ton of updates since the last episode. So much that I had to break it up into two episodes. The next one will be out next week. Today I'm going to talk about new approvals of old medications from new ketamines KETARx and Nrx100 to Tonmya(r) (cyclobenzaprine) for fibromyalgia. Then, I'll also talk about some combination products containing atomoxetine (Strattera(r)) for obstructive sleep apnea. Lastly, I'll then go into a couple medications with new Phase II trial data for depression. First is a unique vasopressin 1b antagonist and the second is a selective orexin receptor antagonist. I do a bit more discussion on these topics than in the previous update episode because honestly I'm not happy about a lot of this and I want to use these new approvals to talk about the deeper issue of how these drug companies manipulate to make money. Please have a listen!

#56 Obesity Medicine: Medical Effects of Obesity and Assessing the Obese Patient

Today I will be presenting my second episode on obesity medicine. I will go over how obesity reeks havoc on every system in the body, what medical conditions are increased by being obese, the increased risk of psychiatric disorders from obesity, and the long list of cancers that are at increased risk from obesity. I think you all will be surprised just how much obesity impacts health. Many of you may not be aware of how linked obesity is with psychiatric illness. Also I think you will be surprised just how many types of cancer are affected and how strongly. After that I will talk about how to do a thorough assessment, basically the history and physical, for a patient with obesity. We need to rule out other causes, assess motivation for treatment, and assess common comorbidities. This is great foundational information that I think you will find super helpful!

#55 ADHD: Diagnosis, Comorbidities, and Differential 

Flipping back to ADHD today, I continue with the background information. I'll go over how to diagnose. I'll go over the criteria but of course I'll be giving you the subtleties of how to flush that out. I'll also talk about both mental health and medical disorders that often go along with ADHD, and I'll talk about the long list of other diagnoses that may look like ADHD with a special focus on bipolar disorder.

 #54 Obesity Medicine and Lifestyle Psychiatry: Obesity Measurements, Rates, Trends, and Etiologies

Today I will start a new season of This Is Your Brain On Drugs Psychiatry Podcast. I mentioned the dual season of ADHD with Obesity Medicine and Lifestyle Psychiatry. Last week I started with ADHD and today I will start the series on Obesity Medicine. I'll do an introduction where I talk about measuring obesity, rates of obesity, trends over time, and etiologies of obesity. I think you will find the discussion on etiology to be especially interesting. I decided to include my lectures on lifestyle and nutritional psychiatry into this series as well as these treatments can treat obesity but also are very useful in treating depression, anxiety, and other psychiatric conditions. So, there will be a lot on those topics before I start talking about the medications to treat obesity. I'm really excited to do this season. It's the one that I've been waiting to do for a year, so I hope you enjoy!

#53 Attention Deficit Hyperactivity Disorder (ADHD): Background and Pathophysiology

Today I start a new season of This Is Your Brain On Drugs Psychiatry Podcast. I will do a dual season where I will go back and forth each week between a season on ADHD and a season on Obesity Medicine and Lifestyle Psychiatry. Today I will start with ADHD. I will do a background on ADHD and discuss its possible causes. I think you will enjoy this introduction and discussion on the background of ADHD. I'll do the usual where I discuss what the science says and give my opinions and clinical insights. Have a listen!

#52 Depression Differential: When to Consider Bipolar Disorder or Something Else

I had an after thought after finishing the depression season, and that is what happens when someone has depressive symptoms that looks like a depressive disorder but it isn't? We will cover all of these diagnoses and their treatments in the future but I think it is prudent to have a discussion on how depressive symptoms look different in different illnesses and how that can affect the medication that you select. And most importantly we want to consider bipolar disorder, so I do a deep dive on bipolar disorder and talk about the old diagnosis of manic depressive illness from DSM-II days where these illnesses were one in the same and both would be treated with a mood stabilizer. There have actually been several different types of depression or manic depressive illness suggested, so have a listen to learn more.

#51 Procedures: Bright Light Therapy, Vagal Nerve Stimulation, Transcranial Magnetic Stimulation, Cranial Electrotherapy Stimulators

Today I will finish up on psychiatric procedures for depression. I will discuss bright light therapy, vagal nerve stimulation, transcranial magnetic stimulation, and cranial electrotherapy stimulators. Some of these are really cheap, others expensive; some are really invasive, some not at all. So there is a range of accessibility. Most of these are quite effective and adverse effects are generally pretty low. You're probably familiar with some of them and not with others, so take a listen and learn about how these work, how you can give to your patients, and what the evidence is for effectiveness. 

#50 Electroconvulsive Therapy: The Most Effective Treatment in Psychiatry

Today I talk about Electroconvulsive Therapy or ECT. This is the most effective treatment in psychiatry with effect sizes off the charts and comparable to treatments for other medical disorders. It's used a lot more than you probably think but not used enough. I'm no expert in ECT. I've done it under supervision, but I'm not certified in it. But that doesn't mean that I can't tell you all about its virtues. In this podcast that's what I'll do. I'll tell you about its effectiveness, how its done, what it can treat, and how to do a thorough medical review to make sure that a patient is safe to have it done. What I'll leave for the expert to explain is exactly how to perform it, but I think even if you practice ECT that you will learn a lot from this episode, so please have a listen!

Quick Take #2: July Updates!: FDA Denies New Treatment for PTSD, Alcohol Intake Limit Recommendation Ends?, New BBW on SSRIs?, Clozapine REMS Ends!, New Psychedelic for Depression?, and Many More!

Hey All, I'm starting up a new series that will contain several snippets of updates in the psychopharm world. Every month or two I will plan to release an episode where I don't deep dive like normal, but instead cover several important breaking news items that affect psychopharmacology and give my quick take on the news. Some of this will be trial results, FDA updates, interesting papers that were recently published, and anything else I can come up with. Today I have a ton of stuff to tell you about. FDA discussion on BBW on SSRIs for pregnancy, clozapine REMS ends, clozapine semaglutide trial, online ADHD prescription assessment, new psychedelic trial results for treatment resistant depression, change in alcohol intake recommendations, new warning on stimulants, new Alzheimers drug donanemab approved for label change indicating improved safety over competitors, new study on vaping for tobacco cessation, BBW removal for HRT?, FDA decision on brexpiprazole combo for PTSD, and study results on the effects of gabapentin on long-term cognition. I really packed a lot in to this shorter episode. Please have a listen!

#49 NAC, Creatine, Aromatherapy, Unfounded Alternative Treatments, and Complementary Medicine Wrap-Up 

Today I will be finishing up the complementary treatments for depression. I'll briefly cover three more treatments that have some evidence and no risk for effect: n-acetylcysteine, creatinine, and aroma therapy. Then I'll mention a number of treatments that as far as I can tell have no evidence that they work better than placebo, some of which could be harmful. Then I'll do a wrap-up of complementary treatments and discuss how these can be useful for your practice and why you shouldn't just write them off and nonsense or less effective. It went a little longer than I was hoping for but I think you will enjoy this finish to our complementary and alternative medicine series.