This Is Your Brain On Drugs Psychiatry Podcast

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 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, 5th choice, and beyond. And also find out my t...

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. H...

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 t...

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!

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 cou...

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 ou...

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...

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...

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 sec...

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. We will talk about venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), milnacipran (Savella), and levomilnacipran (Fetzima). So if you aren't quite sure what is differe...

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!

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. We will discuss fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). I also discuss how the placebo eff...

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...

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 ove...

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 lo...

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...

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...

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'...

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 i...

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 epis...

Trailer to the new podcast This Is Your Brain on Drugs.

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 wag...