Episode List
My very first episode where I introduce myself, the podcast format, my philosophy, talk about my target audience, let you know what my information sources are, and explain how this podcast is different than other podcasts out there. Please have a listen and let me know what you think!
Let's get started learning some basics about depression before we dive into medication treatments. From what exactly is it to where do we think it comes from, even if you are a seasoned veteran I'm betting you will learn something from this introduction to the most frequently prescribed psychiatric medications.
I'm hitting my stride here in episode 3 where I continue with introducing depression. In this episode I'll discuss how to diagnose and assess depression in preparation for deciding on what treatment will work best for the patient. Tune in to find out my approach to this fundamental element that will prepare you for picking the right med or no med.
Today I'll start talking about treatments for depression. I'll go over lifestyle modification recommendations, psychotherapy, complementary treatments, and somatic treatments. I'll cover the last two in more detail later in the depression series, and I'll start the next episode with an overview of antidepressants.
In this shorter episode I'll give the back story on antidepressants. What was used before they were around? How do they work? Join me to find out!
It's episode 6 and we're talking about the first antidepressants, the MAOi's! How do this things work? Aren't they really dangerous and not used anymore? No and No!! You too can use these medications to treat depression. Listen and find out how!
Taking a short break from the antidepressants to talk about all of the receptors in the brain (and some outside) that I think about when I'm thinking about psychiatric medications. The next podcast is about tricyclic antidepressants and I think this is a good time to introduce this concept. The tricyclics have complicated interactions with these receptors as do the antipsychotics that we will talk about later, but most psychiatric medications do what they do through a variety of combinations and strengths at these receptors to include the MAOis that we talked about in the last episode. Let's learn more about them!
Now that we better understand the neuroreceptors in our brains, let's tackle the tricyclic antidepressants. These used to be a mainstay of psychiatric medication treatment for depression. Not so anymore as we have safer medications that have WAY less adverse effects, but they're still used; not as much for depression but for their other effects like with chronic pain, poor sleep, and more. I'd wager primary care uses them more than psychiatrists. They can help but they sure can hurt as well. Let's find out more about them!
Let's get to know the second generation antidepressants, otherwise known as receptor selective antidepressants. These antidepressants started in the 1980s with the newest one coming out just last year. They tend to only mingle with one or two receptors and have much lower adverse effects than the MAOis and TCAs. They are what most of us think about when we think about antidepressants. In this episode we do an overview of them from FDA approved uses to off label uses. And at the end a little bonus content. I talk about contraindications of the TCAs which I missed in the last episode.Now that we better understand the neuroreceptors in our brains, let's tackle the tricyclic antidepressants. These used to be a mainstay of psychiatric medication treatment for depression. Not so anymore as we have safer medications that have WAY less adverse effects, but they're still used; not as much for depression but for their other effects like with chronic pain, poor sleep, and more. I'd wager primary care uses them more than psychiatrists. They can help but they sure can hurt as well. Let's find out more about them!
Today I'm talking about QTc prolongation. This is an adverse effect of many medications and medical conditions, and psych drugs are right up at the top of the list. I think about antidepressants and antipsychotics when I think QTc and psych drugs, so before we go further with antidepressants, let's learn more about QTc prolongation. What is it? What do I do about it? When do I do something about it? How? I mean I'm not a cardiologist. Well, you can handle this. Let me help you by listening to this episode!
This is a big one! So I chopped it into two episodes. We're talking about sexual adverse effects associated with serotonergic medications. This is a huge adverse effect and it's the one that probably bothers the most patients, but it can be uncomfortable to talk about, so let's talk about it. What can we do about this adverse effect while still getting the positive effect from the medication. Let's start by going over why it happens and some techniques to stop it if it does. Then in Part 2 I'll go into depth on the PDE5 inhibitors like Viagra.
Hey. Last time in Part 1 I went over the mechanism of sexual dysfunction and some treatments. In Part 2 we dive into PDE5 inhibitors like Viagra. These medications are not only useful for sexual dysfunction associated with psychiatric medication use but we all know they are used for this on their own, so I think you will find this episode really informative. You may not know the difference between the PDE5 inhibitors. Well I'll be covering that on this episode! And a little bonus. I'll talk about some of the supplements patients may be buying online or at the gas station. This is a topic we don't get in medical school and it's really important so please have a listen!
Ever wonder about that pesky "black box" warning on all those antidepressants? Have you ever considered not prescribing to a patient based on that warning or wonder if maybe you shouldn't? Well, then this episode is for you. I'm going to go through the history of this warning, it's intent, and it's consequences. And I hope that after listening that you will feel comfortable prescribing despite the warning because you know what to do with it.
I'm sure you've all heard about serotonin toxicity AKA syndrome, and you might even know what it looks like and how to diagnosis it, but do you know what causes it and what medications to REALLY be concerned about? Have you read a bunch of lists of meds and wondered if they all really contribute to this syndrome? When I was an intern I learned from psychiatry that you would have to take a truck load of SSRIs to die from, but then when I was talking to the senior internal medicine resident about how safe they are, she pointed out, "What about serotonin syndrome?" Well, what about it? All you questions will be answered on this episode, so I hope you enjoy!
Most of the serotonin medications are pretty darn safe, but they come with a pretty long list of adverse effects that can make patients really uncomfortable. In the previous few episodes, I went over some of the biggest and most dangerous adverse effects. On this episode I want to go over the rest of them. I'll talk about the adverse effects in general and then each of the ones we haven't gone over yet, and I'll also talk about what to do about them if they happen. How to talk to patients about them and how to manage them if they occur. These effects can occur with any of the medications we've discussed thus far and with many of the ones to come. Serotonin is a major target for depression and anxiety, so it's important to understand these in more depth so that we can educate our patients, so let's go!
Well we've finally reached the most commonly prescribed psychiatric medications. Doctors of all ilks prescribe the SSRIs for a myriad of conditions, but do you know as much about them as you think you do? Well we've already covered the plethora of adverse effects that can come with increasing serotonin, but now we dive into the selective serotonin reuptake inhibitors. On this episode I'll go over basic prescribing tips and tricks, discuss drug-drug interactions and SSRI withdrawal syndrome, and give my advantages and disadvantages of this drug class. I hope you enjoy!
On this episode I continue with the SSRIs. In the last episode we discussed them as a class, but today I'll go over each individual SSRI and highlight the subtle differences, advantages, and disadvantages to each med. I also discuss how the placebo effect has such a strong impact on the effectiveness of these medications and how different providers exert very different boosts in effectiveness of these medications. These are meds that all docs prescribe, and they are pretty straightforward, but I think you'll learn a thing or three on this one. Have a listen!
Moving on to the next class of antidepressants after the SSRIs is the SNRIs. In this episode I'll discuss what is unique about these medications and what makes them different from their close cousins the SSRIs. I'll cover them as a class on this episode and individually in the next. Enjoy!
I hope you enjoyed the overview of the SNRIs from the last episode. Today I continue with the SNRIs and go through each of the five individually and give you my classic what I like and don't like about each one. So if you aren't quite sure what is different about the drugs in the class, give this episode a listen and find out and also get a healthy dose of my opinions!
Merry Christmas. I have a special song for you today as we start the atypical antidepressants. We've finished with the typical antidepressants and now it's time to learn about the so-called atypical antidepressants, and going in chronological order, first up are the serotonin antagonist and reuptake inhibitors. We have two drugs in this class. First, the very commonly prescribed trazodone, and second, the rarely if ever prescribed nefazodone. Find out why that is and learn several things that you probably didn't know about them. My guess is there's more than you thought!
For today's antidepressant category of norepinephrine and dopamine reuptake inhibitor, we just have one medication, bupropion, but it is a very special antidepressant because its adverse effect profile is so much different than all of the other antidepressants we have talked about, and it is this adverse effect profile that makes bupropion often my first choice for patients not only for depression but also anxiety. Listen and find out why!
Today I'm talking about mirtazapine, which is in a class of its own as both a noradrenergic and selective serotonergic antidepressant and a tetracyclic antidepressant. It has some very unique qualities that make it a great pick for some patients, and its the only option when you need this unique combination of characteristics. I use this one from time to time but not too frequently because of the weight gain adverse effect. But mirtazapine is more than just an antidepressant that causes weight gain and sedation. Tune in to find out.
We are making our way through the atypical antidepressants and up next are the so called serotonin modulators and stimulators, vilazodone and vortioxetine. To me these are more similar to the SSRIs and like the SSRIs they do a little extra on top of serotonin reuptake inhibition, but for these two medications these effects are touted to be better tolerated than the SSRIs. Is that the case? Find out.
Today we have an interesting episode. We are covering the first of a very new class of antidepressants, the NMDA receptor antagonists. These are the first antidepressants approved for use for depression which do not interact with the monoamine system, and many more may be coming out in the future. We will talk about ketamine, its sister, esketamine, and the only oral form, a combination of the cough suppressant dextromethorphan and bupropion. Find out how this new class of antidepressant works for depression and what my opinion is of these new medications!
Today I will be talking all about the most recently approved antidepressant, gepirone ER. I'm really not a fan of this one, and there are several reasons why. I honestly cannot think of a reason ever to use it. So tune in to find out all about it!
On this episode I will be going over all the nuances of dosing the most common antidepressants. I'll talk about the optimal ranges for dosing for most patients, the max doses, and when we can go above the max dose and how high we can go. I will also talk about what doses I start with and how I titrate. I will also discuss a little about why some patients may need doses much lower and much higher than the average patient, and I will touch on hepatic and renal dosing as well. There's a lot more in here than you will find in the prescribing guidelines. I think you will find this detailed information on how to maximize effect and minimize adverse effects with dosing to be really helpful. Enjoy!
In this episode I will be discussing the different mechanisms of action that are being looked at as the next phase of antidepressant medications. I will also talk about drugs that are in Phase 1, 2, and 3 trials, and how those trials are going. These medications are the likely future of antidepressants. We haven't had many new medications until recently, and they may be followed by several more. Hopefully they will help patients that have yet to benefit from what is out there, but only time will tell. Listen to find out more!
So we've talked about all the FDA approved medications for depression. How to you choose which one to use? Have no fear, I have my break down where I go over all the factors that I take into consideration. Let's not be lazy and pick 5 SSRIs before moving on to other options. Learn about my algorithm that will help you pick the best 1st, 2nd, 3rd, 4th, and 5th choice. And also find out my tier list of these medications. What will be S and A tier? What will be F tier? Tune in to find out!
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!
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.
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!
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!
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!
We've learned all about the antidepressants. You know each one of them inside and out. You know how to dose them, how to pick them, and how to follow them throughout the life cycle, but how do you change from one to the other if the patient is not tolerating or not getting efficacy from the one they are on? Well that's what this episode is about. I'll go over all the switching strategies, when to use each one, and how to execute them, so you'll definitely want to check this one out!
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.
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!
Copyright ©2025 This Is Your Brain On Drugs Psychiatry Podcast, All Rights Reserved.