WEBVTT 00:00:18.549 --> 00:00:21.670 Well, welcome back to another episode of your 00:00:21.670 --> 00:00:24.609 favorite pharmaceutical podcast, Your Mom on 00:00:24.609 --> 00:00:28.609 Drugs. My name is Josh and I am the son. And 00:00:28.609 --> 00:00:33.320 I'm... Jenny and I'm the mom. And welcome to, 00:00:33.359 --> 00:00:36.659 I think this is episode 16. And today we're going 00:00:36.659 --> 00:00:39.380 to be covering a topic that we haven't covered 00:00:39.380 --> 00:00:41.340 before. And I don't think anything related to 00:00:41.340 --> 00:00:44.759 mental health, which is the topic of SSRIs, which 00:00:44.759 --> 00:00:48.359 stands for selective serotonin reuptake inhibitors. 00:00:48.659 --> 00:00:52.719 That is a mouthful. But I've got some friends 00:00:52.719 --> 00:00:57.299 who take SSRIs and I think a lot of them are 00:00:57.299 --> 00:01:01.469 like, Why do I take these? Do I need these? And 00:01:01.469 --> 00:01:04.870 what are the side effects? And so that got me 00:01:04.870 --> 00:01:07.790 thinking. I was like, well, I've got a perfect 00:01:07.790 --> 00:01:10.750 family member who I love dearly and is very smart 00:01:10.750 --> 00:01:12.750 who could probably answer these questions. So 00:01:12.750 --> 00:01:16.230 for anybody who's thinking about going on SSRIs 00:01:16.230 --> 00:01:18.230 or going to a psychiatrist to prescribe them, 00:01:18.329 --> 00:01:20.489 we hope this episode will kind of help inform 00:01:20.489 --> 00:01:22.549 you so that you can have an informed discussion 00:01:22.549 --> 00:01:26.790 with your primary. Not your primary, your specialist 00:01:26.790 --> 00:01:30.069 health care provider, right? Yeah, I'm thinking, 00:01:30.230 --> 00:01:33.890 yes. I mean, there could be a primary care provider 00:01:33.890 --> 00:01:37.549 that prescribed them too. They're not just designated 00:01:37.549 --> 00:01:41.129 just for a psychiatrist to prescribe. Okay. Well, 00:01:41.170 --> 00:01:43.650 cool. Well, so let's delve into the world of 00:01:43.650 --> 00:01:47.650 SSRIs. So, Mom, do you want to kind of give us 00:01:47.650 --> 00:01:50.650 a brief overview of what they are and what they're 00:01:50.650 --> 00:01:53.709 for and how we got here in this moment? Yeah, 00:01:53.750 --> 00:01:57.010 I'm going to start first of all, and again, we'll 00:01:57.010 --> 00:01:59.829 get to this as we move on in this discussion, 00:02:00.709 --> 00:02:04.870 but SSRIs are used for a variety of different 00:02:04.870 --> 00:02:06.810 indications, but I'm going to start first of 00:02:06.810 --> 00:02:09.120 all with depression because that's a... That's 00:02:09.120 --> 00:02:11.939 where they started as far as when they got approved 00:02:11.939 --> 00:02:14.439 for use. And so let's first of all talk about 00:02:14.439 --> 00:02:16.479 depression as far as an illness is concerned. 00:02:16.580 --> 00:02:19.780 It's really a serious debilitating disorder for 00:02:19.780 --> 00:02:22.439 those that have been diagnosed with major depressive 00:02:22.439 --> 00:02:26.860 disorder. And despite a lot of different treatment 00:02:26.860 --> 00:02:29.919 options, depressive disorders are difficult to 00:02:29.919 --> 00:02:31.800 manage. And there's a lot of reasons for that. 00:02:31.939 --> 00:02:35.120 One is that you can have high relapse rates despite 00:02:35.120 --> 00:02:37.659 being treated for them. You can have unwanted 00:02:37.659 --> 00:02:40.960 adverse. adverse effects from your therapy. You 00:02:40.960 --> 00:02:44.240 could have co -occurring mental or physical conditions 00:02:44.240 --> 00:02:47.680 that also add to compound that disease state. 00:02:48.099 --> 00:02:51.139 And you could also delay your treatment if you're 00:02:51.139 --> 00:02:54.020 like, you know, there's been definitely a stigma 00:02:54.020 --> 00:02:56.060 associated with mental illness for years. And 00:02:56.060 --> 00:02:57.919 I think that we're breaking through that a bit, 00:02:57.960 --> 00:03:00.360 but there is still that stigma. So it does delay 00:03:00.360 --> 00:03:02.439 people going to get help for mental illnesses. 00:03:03.639 --> 00:03:06.900 I thought this was very fascinating. And in the 00:03:06.900 --> 00:03:12.259 1950s, there was clinical research with antihistamines, 00:03:12.259 --> 00:03:14.960 you know, those drugs that we take for allergies 00:03:14.960 --> 00:03:18.159 and cough and cold. Shout out to our former episode 00:03:18.159 --> 00:03:22.060 on allergies. There you go. Phenothiazines. Phenothiazines 00:03:22.060 --> 00:03:24.439 are drugs that are used in mental health disorders, 00:03:24.599 --> 00:03:28.860 primarily for schizophrenia. And then there's 00:03:28.860 --> 00:03:31.379 other. And then so we've got. antihistamines, 00:03:31.379 --> 00:03:33.139 phenothiazines, and medications that were used 00:03:33.139 --> 00:03:36.099 to treat tuberculosis of all things. And this 00:03:36.099 --> 00:03:38.300 is how we got our first antidepressants used 00:03:38.300 --> 00:03:41.819 because they are discovered because they found 00:03:41.819 --> 00:03:43.840 that although they were being investigated in 00:03:43.840 --> 00:03:46.159 these particular areas, they found that the agents 00:03:46.159 --> 00:03:48.680 that were being investigated actually worked 00:03:48.680 --> 00:03:50.539 to help with depression. Oh, interesting. So 00:03:50.539 --> 00:03:52.340 it was kind of an accident. It was kind of an 00:03:52.340 --> 00:03:53.960 accident. Sometimes that's how drugs are found. 00:03:54.099 --> 00:03:58.280 I know. So the drug class tricyclic antidepressants 00:03:58.280 --> 00:04:00.139 is one that's used to treat. treat depression. 00:04:00.400 --> 00:04:04.500 And so imipramine is one of those tricyclic antidepressants 00:04:04.500 --> 00:04:06.740 and it was found through this mechanism. And 00:04:06.740 --> 00:04:11.800 another drug class that is used to treat depression 00:04:11.800 --> 00:04:15.520 are called monoamine oxidase inhibitors or MAOIs. 00:04:15.759 --> 00:04:17.319 And so there was another agent that came out 00:04:17.319 --> 00:04:20.759 of there, out of that initial research that was 00:04:20.759 --> 00:04:25.519 discovered for depression. The tricyclic antidepressants 00:04:25.519 --> 00:04:28.939 really target norepinephrine, one of our neurotransmitters. 00:04:28.939 --> 00:04:32.800 and the monoamine oxidase inhibitors actually 00:04:32.800 --> 00:04:36.899 target epinephrine, norepinephrine, and dopamine. 00:04:37.139 --> 00:04:39.360 And we're not going to really talk a whole lot 00:04:39.360 --> 00:04:41.180 about those agents. We'll just kind of skirt 00:04:41.180 --> 00:04:43.600 around them. But I just wanted people to be familiarized 00:04:43.600 --> 00:04:46.439 with those drug classes that are also used to 00:04:46.439 --> 00:04:49.480 treat depression. I like that. Are we going to 00:04:49.480 --> 00:04:53.620 do a basic overview of just kind of basic neurobiology 00:04:53.620 --> 00:04:56.939 just for folks out there who... maybe are we 00:04:56.939 --> 00:04:59.300 gonna like what a basic neurotransmitter is like 00:04:59.300 --> 00:05:01.769 what does that do Yeah, I'm going to let you 00:05:01.769 --> 00:05:04.410 do that. Because in that research also, they 00:05:04.410 --> 00:05:08.389 also found that serotonin is also implicated 00:05:08.389 --> 00:05:11.129 in depression. So we've got a lot of different 00:05:11.129 --> 00:05:13.790 neurotransmitters that are implicated in depression. 00:05:13.910 --> 00:05:15.990 So before I get into the prevalence of depression, 00:05:16.209 --> 00:05:19.189 why don't you... Actually, let me do the prevalence 00:05:19.189 --> 00:05:23.089 and then we'll skirt into talking about the... 00:05:23.089 --> 00:05:26.069 Well, let me give a brief overview first because 00:05:26.069 --> 00:05:28.009 I just think it'll set the stage. So we're throwing 00:05:28.009 --> 00:05:32.550 a lot of terms at you. things like norepinephrine 00:05:32.550 --> 00:05:36.009 serotonin dopamine and you've maybe the audience 00:05:36.009 --> 00:05:38.629 has heard of a lot of these chemicals thrown 00:05:38.629 --> 00:05:40.790 around i think people associate dopamine with 00:05:40.790 --> 00:05:43.029 like the pleasure neurotransmitter or hormone 00:05:43.029 --> 00:05:45.329 and then serotonin is like the feel good or like 00:05:45.329 --> 00:05:49.540 social and um If you really take it back to, 00:05:49.639 --> 00:05:51.939 if you look inside of your brain and even in 00:05:51.939 --> 00:05:54.600 your body, there are these certain types of cells 00:05:54.600 --> 00:05:56.360 and you have hundreds of types of cells in your 00:05:56.360 --> 00:05:58.319 bodies that do different jobs. Just like if you 00:05:58.319 --> 00:06:00.019 have a company, you've got a lot of different 00:06:00.019 --> 00:06:03.459 people that do these jobs. So the job of these 00:06:03.459 --> 00:06:05.860 cells called neurons, they're a lot of them. 00:06:05.899 --> 00:06:07.800 Most of them are in your brain. Then you also 00:06:07.800 --> 00:06:10.180 have them all over your body. We distinguish 00:06:10.180 --> 00:06:13.600 between the central versus the peripheral nervous 00:06:13.600 --> 00:06:15.939 system. The central nervous system is your brain 00:06:15.939 --> 00:06:18.610 and your peripheral is like, All over your body, 00:06:18.689 --> 00:06:20.689 like how you can feel things in your fingertips, 00:06:20.850 --> 00:06:23.649 for example. Or your toes. Or your toes. Heads, 00:06:23.649 --> 00:06:27.089 hands, shoulders, knees, and toes. So if you're 00:06:27.089 --> 00:06:32.069 thinking like, okay, if I stub my toe, then how 00:06:32.069 --> 00:06:35.110 does the signal from the toe get to my brain 00:06:35.110 --> 00:06:37.449 to be able to perceive, hey, I just stubbed my 00:06:37.449 --> 00:06:41.819 toe. And that is. used by, they're mainly electrical 00:06:41.819 --> 00:06:46.579 signals. And the signal is passed between cells, 00:06:46.740 --> 00:06:50.319 kind of almost like a yarn of string, where you 00:06:50.319 --> 00:06:53.639 have certain knots that are basically the connections 00:06:53.639 --> 00:06:58.399 on the string. And where those knots are is essentially 00:06:58.399 --> 00:07:00.800 not, it's not really a knot in a neuron, it's 00:07:00.800 --> 00:07:03.100 a space. And we call that space the synapse. 00:07:03.319 --> 00:07:06.720 And so when one nerve wants to send a signal 00:07:06.720 --> 00:07:09.540 to the other nerve that's to the next to it, 00:07:09.579 --> 00:07:12.000 there's a gap in between. So it's thinking, shoot, 00:07:12.180 --> 00:07:14.160 I got to cross this gap and I don't know how. 00:07:15.040 --> 00:07:18.579 So for some reason, biology invented this mechanism 00:07:18.579 --> 00:07:22.720 of sending these things called neurotransmitters, 00:07:22.779 --> 00:07:25.740 which essentially carry a signal from one nerve 00:07:25.740 --> 00:07:28.560 to another. And depending on the type of nerve 00:07:28.560 --> 00:07:31.439 and the type of signal, it'll either send dopamine, 00:07:31.720 --> 00:07:35.660 serotonin. GABA. There's a lot of different types 00:07:35.660 --> 00:07:40.459 of signals. And based on the concentration of 00:07:40.459 --> 00:07:42.860 this signal, meaning how much serotonin you have 00:07:42.860 --> 00:07:45.420 or how much GABA you have, it'll either excite 00:07:45.420 --> 00:07:47.720 the next neuron being like, oh, I want to tell 00:07:47.720 --> 00:07:49.720 this message to the next neuron. Or it'll be 00:07:49.720 --> 00:07:52.819 like. don't tell this message to the next neuron. 00:07:52.959 --> 00:07:55.439 So we call them excitatory or inhibitory neurons. 00:07:55.839 --> 00:07:59.120 And depending on what type of neurotransmitter 00:07:59.120 --> 00:08:01.120 you're dealing with and how much of it you have 00:08:01.120 --> 00:08:03.319 in a certain amount of time, you will send a 00:08:03.319 --> 00:08:08.009 very strong or long lasting or weak. So whenever 00:08:08.009 --> 00:08:10.009 we're talking about things like neurotransmitters, 00:08:10.089 --> 00:08:11.629 literally thinking about it like a game like 00:08:11.629 --> 00:08:14.089 telephone that you played in kindergarten where 00:08:14.089 --> 00:08:16.110 it's like I'm telling you a secret, then you 00:08:16.110 --> 00:08:18.610 tell the next person. And that signal is going 00:08:18.610 --> 00:08:21.029 from one area of your body or one area of your 00:08:21.029 --> 00:08:23.009 brain to another area of your brain. And that's 00:08:23.009 --> 00:08:25.250 just going to basically carry a signal. So just 00:08:25.250 --> 00:08:27.269 wanted to set the stage for that. So when you 00:08:27.269 --> 00:08:29.610 listen to Dr. Seltzer talk about neurotransmitters, 00:08:29.689 --> 00:08:31.930 you have this kind of idea in your mind of how 00:08:31.930 --> 00:08:33.710 these signals are being sent. Okay. That's a 00:08:33.710 --> 00:08:38.200 great explanation, Josh. And so I'm just, I'm 00:08:38.200 --> 00:08:40.539 really, we're going to talk about other disease 00:08:40.539 --> 00:08:42.899 states, but I'm really just giving a lot of the 00:08:42.899 --> 00:08:45.460 main details about depression since it's going 00:08:45.460 --> 00:08:49.960 to be the one that we. deal with a lot. So the 00:08:49.960 --> 00:08:53.580 lifetime prevalence of depression has been estimated 00:08:53.580 --> 00:08:56.720 to be about 15%. And this is for unipolar depression. 00:08:56.899 --> 00:08:58.919 And when I say unipolar depression, that means 00:08:58.919 --> 00:09:02.779 that you don't have the manic component of bipolar 00:09:02.779 --> 00:09:05.460 disorder associated with it, but it's just major 00:09:05.460 --> 00:09:10.480 depressive disorder. And about 4 % of the population. 00:09:11.320 --> 00:09:13.379 worldwide experience depression that's about 00:09:13.379 --> 00:09:15.820 300 million people i never knew that's where 00:09:15.820 --> 00:09:18.220 bipolar came from where it's like you have the 00:09:18.220 --> 00:09:21.000 depressive symptoms but then you also have the 00:09:21.000 --> 00:09:24.019 manic yes so it's just called unipolar depression 00:09:24.019 --> 00:09:26.950 yeah Oh, interesting. So bipolar is almost kind 00:09:26.950 --> 00:09:29.870 of a form of depression, but with a manic state. 00:09:29.950 --> 00:09:34.169 Absolutely. And again, I am not a psychiatrist 00:09:34.169 --> 00:09:37.570 and I'm not a pharmacist that specializes in 00:09:37.570 --> 00:09:40.909 psychiatry, but I believe in patients with bipolar 00:09:40.909 --> 00:09:43.370 disorder, they spend a lot more time in depression 00:09:43.370 --> 00:09:46.789 than they do in mania or hypomania and stuff. 00:09:46.850 --> 00:09:49.250 But those episodes do definitely happen and that's 00:09:49.250 --> 00:09:51.250 how they get characterized differently. That's 00:09:51.250 --> 00:09:52.629 really interesting. I've always wondered where 00:09:52.629 --> 00:09:55.100 the term bipolar comes from. Makes a lot of sense. 00:09:56.600 --> 00:09:58.879 Females will be affected with depression twice 00:09:58.879 --> 00:10:03.440 as much as men or males. And interestingly, over 00:10:03.440 --> 00:10:08.340 the years 2005 to 2020, depression rates in 18 00:10:08.340 --> 00:10:13.600 to 25 -year -olds had doubled. Do you think that's 00:10:13.600 --> 00:10:15.580 due to – I'm sure we're just speculating. Do 00:10:15.580 --> 00:10:19.009 you think that's just due to – better diagnostic 00:10:19.009 --> 00:10:22.309 or just like, or maybe, you know, you think, 00:10:22.429 --> 00:10:25.210 I mean, it was before the pandemic, you know, 00:10:25.210 --> 00:10:27.070 cause that definitely caused some issues with 00:10:27.070 --> 00:10:30.090 younger people and stuff. But I mean, life just 00:10:30.090 --> 00:10:32.129 gets harder, you know, and stuff. And may I, 00:10:32.169 --> 00:10:35.350 you know, and I, you know, definitely different 00:10:35.350 --> 00:10:37.289 than when I was a kid, you know, and stuff. So 00:10:37.289 --> 00:10:40.029 I don't know if that's, you know, with you, the, 00:10:40.029 --> 00:10:45.079 all the whole social media, you know, trend, 00:10:45.079 --> 00:10:47.019 you know, with, you know, I don't know if that 00:10:47.019 --> 00:10:49.019 amplifies, you know, like, you know, I've got 00:10:49.019 --> 00:10:50.740 to get this many likes and not, you know, I'm 00:10:50.740 --> 00:10:53.299 not accepting. I don't know if that really, that's 00:10:53.299 --> 00:10:55.539 only speculation on my part. I'm just more wondering 00:10:55.539 --> 00:10:57.759 is like, if we see more of it and you said that 00:10:57.759 --> 00:11:00.139 there was a bit of a social stigma, I think there's 00:11:00.139 --> 00:11:02.480 been always a social stigma around mental health. 00:11:02.519 --> 00:11:04.559 I know you've dealt with that personally of just 00:11:04.559 --> 00:11:06.539 like, even when I remember you got in that car 00:11:06.539 --> 00:11:09.200 accident and people were just expecting you to 00:11:09.200 --> 00:11:11.509 get back to work. you know, really quick. It's 00:11:11.509 --> 00:11:13.710 like, yeah, whatever's in your brain, like you 00:11:13.710 --> 00:11:15.389 just got to get messed up. You got to get over 00:11:15.389 --> 00:11:17.049 it. And like, you don't treat it like a broken 00:11:17.049 --> 00:11:20.250 leg. It's for some reason we, we haven't approached 00:11:20.250 --> 00:11:22.330 mental health the way we do physical health until 00:11:22.330 --> 00:11:26.350 recently. Yes. I think behavioral changes make 00:11:26.350 --> 00:11:28.529 us feel uncomfortable. You know, it's a lot different 00:11:28.529 --> 00:11:30.590 than if somebody has high blood pressure, you 00:11:30.590 --> 00:11:32.450 know, so that's a really good point. Yeah. Yeah. 00:11:32.509 --> 00:11:34.509 You can have a really pleasant cancer patient, 00:11:34.549 --> 00:11:37.730 but a really unpleasant bipolar patient. Yeah. 00:11:37.750 --> 00:11:41.110 Even if they're really healthy. Yeah. Interestingly 00:11:41.110 --> 00:11:44.029 and sadly, about 10 % to 15 % of patients with 00:11:44.029 --> 00:11:47.450 depression will also attempt suicide. And anxiety 00:11:47.450 --> 00:11:53.129 peers up or accompanies depression in about 50 00:11:53.129 --> 00:11:56.070 % to 75 % of patients. So it's not uncommon to 00:11:56.070 --> 00:11:58.529 have a patient that both has depression as well 00:11:58.529 --> 00:12:00.830 as has some sort of anxiety disorder as well. 00:12:01.740 --> 00:12:04.080 So like I've talked about, depression is a more 00:12:04.080 --> 00:12:07.740 common mental illness. And there are different 00:12:07.740 --> 00:12:10.539 factors that may contribute to depression. You've 00:12:10.539 --> 00:12:13.080 got some genetic factors. So if you have a blood 00:12:13.080 --> 00:12:16.059 relative with depression, you would be more likely 00:12:16.059 --> 00:12:19.679 to have depression. Biological changes. If you're 00:12:19.679 --> 00:12:22.059 taking a particular medication or you have certain 00:12:22.059 --> 00:12:24.419 medical problems, they can contribute to developing 00:12:24.419 --> 00:12:27.139 depression. We've talked about cancer patients. 00:12:27.299 --> 00:12:30.279 When you're facing potentially mortality, that 00:12:30.279 --> 00:12:33.080 could trigger having depressive episodes. And 00:12:33.080 --> 00:12:36.279 so that's very realistic. Environmental issues. 00:12:36.399 --> 00:12:40.559 So if you use alcohol or drugs, that can contribute 00:12:40.559 --> 00:12:44.259 to depression. And psychological issues. So if 00:12:44.259 --> 00:12:46.980 you've been abused, if you've had a traumatic... 00:12:47.240 --> 00:12:49.419 life event or a traumatic event that can also 00:12:49.419 --> 00:12:53.919 contribute to a depressive disorder. So there 00:12:53.919 --> 00:12:58.299 are actual clinical definitions for all the mental 00:12:58.299 --> 00:13:01.299 health disorders. And it's in a book called the 00:13:01.299 --> 00:13:05.600 DSM -5. It stands for the Diagnostic and Statistical 00:13:05.600 --> 00:13:10.159 Manual of Mental Disorders. So DSM, yes, DSM 00:13:10.159 --> 00:13:12.820 -5. And the five stands for the fifth edition. 00:13:13.720 --> 00:13:16.600 And so you can pull up this resource and it will 00:13:16.600 --> 00:13:20.580 tell you in specifics and very much detail the 00:13:20.580 --> 00:13:26.799 criteria for getting diagnosed with a particular 00:13:26.799 --> 00:13:30.559 mental health disorder. Because mental health 00:13:30.559 --> 00:13:33.799 disorders are... You know, we can think we're 00:13:33.799 --> 00:13:36.679 depressed or we can think we're anxious, but 00:13:36.679 --> 00:13:39.019 then it goes away really quickly, you know, and 00:13:39.019 --> 00:13:41.500 stuff. Because you're having a bad day, you know. 00:13:41.820 --> 00:13:44.360 Yeah, I feel like that's probably the hard and 00:13:44.360 --> 00:13:47.399 sticky thing about mental health disorders is 00:13:47.399 --> 00:13:50.940 that the line between normal behavior, quote 00:13:50.940 --> 00:13:54.360 unquote, versus a disorder can be quite blurry. 00:13:54.519 --> 00:13:57.399 Like you said, I've definitely been in a temporary 00:13:57.399 --> 00:14:00.559 depressive state, as you know, as my mother. 00:14:00.659 --> 00:14:03.860 And it's like. But then, yeah, with enough time, 00:14:03.879 --> 00:14:06.500 you're able to kind of get out of it. But when 00:14:06.500 --> 00:14:09.000 you're in that mode of feeling depressed, it 00:14:09.000 --> 00:14:11.000 is hard to imagine that you're going to feel 00:14:11.000 --> 00:14:16.100 any better. And so it's got to be really interesting 00:14:16.100 --> 00:14:20.600 to look at a patient and see them going through 00:14:20.600 --> 00:14:23.220 these symptoms and wondering, is this severe 00:14:23.220 --> 00:14:27.480 depression? Is this minor depression? Like you 00:14:27.480 --> 00:14:30.320 said, I imagine it's also good for codifying 00:14:30.320 --> 00:14:32.740 this stuff for insurance reasons, right? So like 00:14:32.740 --> 00:14:35.139 at the end of the day, it's like, okay, I need 00:14:35.139 --> 00:14:37.440 this list of criteria and I know it's a bit fluid, 00:14:37.519 --> 00:14:39.460 but at the end of the day, I've got to call it 00:14:39.460 --> 00:14:42.419 something so that I can justify the intervention 00:14:42.419 --> 00:14:44.820 I'm going to prescribe to this individual, right? 00:14:45.059 --> 00:14:49.000 Right. And too, I think a patient's going to 00:14:49.000 --> 00:14:52.519 get to the point where it's like, I can't handle 00:14:52.519 --> 00:14:58.879 this myself. Typically, depression, you have 00:14:58.879 --> 00:15:01.120 to have at least five or more symptoms out of 00:15:01.120 --> 00:15:03.620 this whole long list of symptoms. It could be 00:15:03.620 --> 00:15:06.740 that you're feeling really sad or that you don't 00:15:06.740 --> 00:15:11.259 have an interest in daily activities, that you 00:15:11.259 --> 00:15:13.700 have changes in your sleep or your eating patterns. 00:15:13.840 --> 00:15:17.820 And they're there almost every day and it has 00:15:17.820 --> 00:15:22.379 to last for at least two weeks. And so it causes 00:15:22.379 --> 00:15:24.320 you to have impairment that you just want to 00:15:24.320 --> 00:15:28.230 not. participate in life anymore. And you also 00:15:28.230 --> 00:15:31.009 have to get, this is another reason I think you 00:15:31.009 --> 00:15:33.250 go to a healthcare provider is to make sure that 00:15:33.250 --> 00:15:35.830 it's not due to some other medical disorder because 00:15:35.830 --> 00:15:38.129 depression sometimes can mimic other disorders. 00:15:38.570 --> 00:15:43.750 So then you've got a label per se, you know, 00:15:43.750 --> 00:15:46.629 but you're not, you don't get the label so that 00:15:46.629 --> 00:15:48.009 somebody could say, oh, there goes that oppressed 00:15:48.009 --> 00:15:51.009 patient. But it's like, okay, now we can figure 00:15:51.009 --> 00:15:53.990 out if you want to do something about this. Now 00:15:53.990 --> 00:15:57.340 we've got some. we've got some avenues in which 00:15:57.340 --> 00:16:01.360 to tackle this particular condition. So. That's 00:16:01.360 --> 00:16:03.399 a good point. It's like, it's someone who, you 00:16:03.399 --> 00:16:05.419 know, you might have high sodium and it's just 00:16:05.419 --> 00:16:07.500 like, you need to know that you have high sodium 00:16:07.500 --> 00:16:09.000 so that you can do something about it. And then 00:16:09.000 --> 00:16:11.480 maybe potentially become a person with normal 00:16:11.480 --> 00:16:14.779 sodium levels in your blood. But like, no one's 00:16:14.779 --> 00:16:17.379 going to say there's a high sodium person. They're 00:16:17.379 --> 00:16:19.320 just going to say, this is a, hopefully a temporary 00:16:19.320 --> 00:16:22.320 condition or a temporary state that we can help 00:16:22.320 --> 00:16:25.820 you get through. Right. And just speaking to 00:16:25.820 --> 00:16:28.139 anybody who's going through depression or anxiety, 00:16:28.519 --> 00:16:32.159 I've been there. And it really, it's such a perverse 00:16:32.159 --> 00:16:35.860 feeling because you would think that when you're 00:16:35.860 --> 00:16:37.580 depressed, you would want to get help and you 00:16:37.580 --> 00:16:39.240 would want to do the things that make you better. 00:16:39.299 --> 00:16:40.919 But actually you want to do all the opposite 00:16:40.919 --> 00:16:43.259 things to make you better. So when you're feeling 00:16:43.259 --> 00:16:45.419 this way, the hardest thing in the world to do 00:16:45.419 --> 00:16:47.779 is actually to do the things that make you better, 00:16:47.860 --> 00:16:50.399 which is to get help, talk to friends, exercise. 00:16:50.860 --> 00:16:52.120 And we're going to talk about all this stuff 00:16:52.120 --> 00:16:56.379 later. I know it feels so dark. I've been there. 00:16:56.460 --> 00:16:58.220 I've been there. Like, I just wish I didn't feel 00:16:58.220 --> 00:17:01.899 this way anymore. And you probably will for a 00:17:01.899 --> 00:17:03.919 bit, but that's why it's really good to seek 00:17:03.919 --> 00:17:05.559 somebody else who's not feeling the way that 00:17:05.559 --> 00:17:07.539 you're feeling so they can kind of like be your 00:17:07.539 --> 00:17:10.559 eyes for you and like let you know that there 00:17:10.559 --> 00:17:13.480 is a lighter side to this. Because even like 00:17:13.480 --> 00:17:15.440 six months ago, my mom can tell you I was going 00:17:15.440 --> 00:17:18.200 through tough stuff and I was, oh my gosh, I 00:17:18.200 --> 00:17:22.500 was so sad. And just being here now. so light. 00:17:23.119 --> 00:17:25.640 It's pretty amazing. I would want to tell my, 00:17:25.640 --> 00:17:28.839 my, my former self six months ago, like it's 00:17:28.839 --> 00:17:30.819 going to be okay, but you really don't feel that 00:17:30.819 --> 00:17:34.119 way in the moment. Yeah. Well, so we talked about 00:17:34.119 --> 00:17:36.200 the fact that one of the, and the reason that 00:17:36.200 --> 00:17:39.400 we're talking about serotonin we're targeting 00:17:39.400 --> 00:17:42.440 serotonin today, as far as one of those neurotransmitters 00:17:42.440 --> 00:17:46.950 that is uh, targeted as far as treatment and 00:17:46.950 --> 00:17:48.950 depression is because we're talking about selective 00:17:48.950 --> 00:17:51.750 serotonin reuptake inhibitors. So let me give 00:17:51.750 --> 00:17:54.009 you a little tiny bit of a background about serotonin. 00:17:54.109 --> 00:17:56.990 Like Josh said earlier, serotonin is one of the 00:17:56.990 --> 00:17:59.329 chemicals that can carry messages between nerve 00:17:59.329 --> 00:18:02.569 cells in the brain and throughout the body. And 00:18:02.569 --> 00:18:04.910 like he also mentioned too, that normal levels 00:18:04.910 --> 00:18:08.509 of serotonin can produce focus, emotional stability, 00:18:08.890 --> 00:18:11.910 calmness, and happiness. So serotonin is a good 00:18:11.910 --> 00:18:14.670 neurotransmitter to have. you know, higher levels 00:18:14.670 --> 00:18:19.430 of. One of the theories as far as why depression 00:18:19.430 --> 00:18:25.769 happens is that these neurotransmitters, serotonin, 00:18:25.769 --> 00:18:29.539 norepinephrine, and dopamine. are decreased. 00:18:30.259 --> 00:18:32.400 And so that there's some sort of, it was called 00:18:32.400 --> 00:18:35.579 the monoamine hypothesis. And so it was used 00:18:35.579 --> 00:18:39.079 for a lot of years. I think 50 years was kind 00:18:39.079 --> 00:18:42.460 of like, and researchers are always looking for 00:18:42.460 --> 00:18:44.500 new things per se, but that kind of stuck for 00:18:44.500 --> 00:18:49.099 a while. There are some newer research ideas 00:18:49.099 --> 00:18:52.839 going out around now as far as why depression 00:18:52.839 --> 00:18:55.339 happens. And so, yes, these neurotransmitters 00:18:55.339 --> 00:19:00.269 are. are implicated and are targeted in the definition 00:19:00.269 --> 00:19:03.230 of depression, but it may not just be that they're 00:19:03.230 --> 00:19:06.230 in lower concentrations, but it could be that 00:19:06.230 --> 00:19:09.309 they're not used effectively. It could be that 00:19:09.309 --> 00:19:13.150 they are produced in an inefficient manner. There's 00:19:13.150 --> 00:19:14.730 a lot of different theories as well, too. So 00:19:14.730 --> 00:19:17.589 I don't stand before you stating that we know 00:19:17.589 --> 00:19:21.009 the exact mechanism why depression happens, but 00:19:21.009 --> 00:19:23.269 we do know that these neurotransmitters are involved. 00:19:24.240 --> 00:19:27.900 So the selective serotonin reuptake inhibitors 00:19:27.900 --> 00:19:32.240 were, so like I mentioned earlier, the earlier 00:19:32.240 --> 00:19:36.980 antidepressants, monoamine oxidase inhibitors 00:19:36.980 --> 00:19:40.539 were shown to inhibit monoamine oxidase. And 00:19:40.539 --> 00:19:44.109 monoamine oxidase has an effect on... dopamine, 00:19:44.309 --> 00:19:47.170 epinephrine, and norepinephrine. So it increased 00:19:47.170 --> 00:19:50.710 their concentrations. And tricyclic antidepressants 00:19:50.710 --> 00:19:53.089 also showed that they blocked the reuptake of 00:19:53.089 --> 00:19:55.269 norepinephrine. So then that meant that you've 00:19:55.269 --> 00:19:57.509 got more norepinephrine, epinephrine, dopamine 00:19:57.509 --> 00:20:01.950 in your synapses to operate. Yeah. Just to clarify 00:20:01.950 --> 00:20:04.869 that point is like when your cell, when your 00:20:04.869 --> 00:20:08.369 neuron is done sending a signal, it just recycles 00:20:08.369 --> 00:20:10.970 that signal, the serotonin or norepinephrine 00:20:10.970 --> 00:20:14.420 back into the original. neuron that sent the 00:20:14.420 --> 00:20:18.099 signal. But if you block the way for it to get 00:20:18.099 --> 00:20:21.380 back inside and it stays in that space, which 00:20:21.380 --> 00:20:23.519 we call the synapse to go to the next thing, 00:20:23.599 --> 00:20:25.700 then the concentration of that will be higher. 00:20:26.079 --> 00:20:28.859 Therefore you increase that in the synapse. So 00:20:28.859 --> 00:20:32.480 by blocking it or, you know, the reuptake inhibitor, 00:20:32.539 --> 00:20:35.720 quote unquote. in the name ssri meaning that 00:20:35.720 --> 00:20:38.240 less of that serotonin will get taken back up 00:20:38.240 --> 00:20:41.059 by the original cell and it'll stay in that synaptic 00:20:41.059 --> 00:20:43.099 cleft which we call that space in between or 00:20:43.099 --> 00:20:45.079 the knot on the yarn as i alluded to earlier 00:20:45.079 --> 00:20:48.359 and you'll get a stronger signal right right 00:20:48.359 --> 00:20:53.079 so in 1960 in the 1960s eli lily which is a pharmaceutical 00:20:53.079 --> 00:20:56.720 manufacturer they showed that molecules could 00:20:56.720 --> 00:21:01.660 also effectively inhibit serotonin. So then that 00:21:01.660 --> 00:21:04.079 led to the birth of selective serotonin reuptake 00:21:04.079 --> 00:21:05.920 inhibitors. And the first one was a drug called 00:21:05.920 --> 00:21:10.700 fluoxetine. And actually it was in 1988. Is that 00:21:10.700 --> 00:21:16.619 Prozac? It is Prozac, yes. So with the development 00:21:16.619 --> 00:21:19.099 of the selective serotonin reuptake inhibitors, 00:21:19.339 --> 00:21:24.079 the usage of antidepressants increased five -fold 00:21:24.079 --> 00:21:29.960 between 1988 to 94 and then the 2015 to 2018. 00:21:30.279 --> 00:21:33.420 It increased five -fold because of SSRIs, because 00:21:33.420 --> 00:21:37.180 they have a better adverse effect profile than 00:21:37.180 --> 00:21:40.099 tricyclic antidepressants and monoamine oxidase 00:21:40.099 --> 00:21:45.519 inhibitors. So, like we talked about, SSRIs inhibit 00:21:45.519 --> 00:21:49.799 the reuptake of serotonin. So, you've got, like 00:21:49.799 --> 00:21:53.180 Josh said, there's more serotonin in the synapse 00:21:53.180 --> 00:21:56.180 to be utilized to send that signal. And remember, 00:21:56.299 --> 00:22:00.000 serotonin causes a more calming feeling and lifts 00:22:00.000 --> 00:22:02.740 the mood and makes it feel happier. So, in depression, 00:22:02.920 --> 00:22:05.440 it's going to work to help with that particular 00:22:05.440 --> 00:22:12.839 aspect of that disease. Oh, let me just give 00:22:12.839 --> 00:22:15.460 a little caveat. I'm sorry. This probably sounds 00:22:15.460 --> 00:22:18.079 like all over the board. But there are selective 00:22:18.079 --> 00:22:21.160 serotonin reuptake inhibitors. There are also 00:22:21.160 --> 00:22:28.180 a couple of medications that are called. Serotonin 00:22:28.180 --> 00:22:31.700 and norepinephrine reuptake inhibitors. So that 00:22:31.700 --> 00:22:34.500 implies they're SNRIs. So that implies that they 00:22:34.500 --> 00:22:38.039 also will block the reuptake of norepinephrine. 00:22:38.140 --> 00:22:40.039 And I believe they have a little bit of an effect 00:22:40.039 --> 00:22:42.700 on dopamine as well, too. So there's a couple 00:22:42.700 --> 00:22:44.779 of agents like that. So they're still blocking 00:22:44.779 --> 00:22:46.920 serotonin, but they're also blocking norepinephrine. 00:22:46.960 --> 00:22:48.500 And we'll get to those names in just a minute. 00:22:50.039 --> 00:22:53.799 The selective serotonin reuptake inhibitors have 00:22:53.799 --> 00:22:57.039 fewer effects than the TCAs, which are the tricyclic 00:22:57.039 --> 00:23:00.059 antidepressants, or the monoamine oxidase inhibitors, 00:23:00.079 --> 00:23:05.339 which are MAOIs, because those agents have antihistaminic 00:23:05.339 --> 00:23:09.039 and anticholinergic effects, and especially the 00:23:09.039 --> 00:23:11.599 anticholinergic effects can cause things like 00:23:12.249 --> 00:23:15.009 urinary retention in men, especially if they 00:23:15.009 --> 00:23:16.829 have enlarged prostates and they already have 00:23:16.829 --> 00:23:18.609 issues with that to begin with. So that can be 00:23:18.609 --> 00:23:21.670 uncomfortable. You can have dry mouth and it's 00:23:21.670 --> 00:23:25.039 harder to pee. It's harder to pee. So, or you 00:23:25.039 --> 00:23:27.460 can have dry mouth, that type of things. And 00:23:27.460 --> 00:23:29.920 tricyclic antidepressants are also associated 00:23:29.920 --> 00:23:33.519 with having different types of cardiac dysrhythmias. 00:23:34.119 --> 00:23:36.660 So the larger doses that you've got that to be 00:23:36.660 --> 00:23:39.400 concerned about as well too. MAOIs have a lot 00:23:39.400 --> 00:23:42.079 of drug interactions with them as well too. And 00:23:42.079 --> 00:23:44.680 you also have food interactions with them. So 00:23:44.680 --> 00:23:46.660 they just became, they're just more complicated 00:23:46.660 --> 00:23:48.920 and it's just more, you have to watch out more 00:23:48.920 --> 00:23:50.660 for how you - It is more restrictive in your 00:23:50.660 --> 00:23:53.000 lifestyle. It's not that you can't use them. 00:23:53.160 --> 00:23:54.900 And we'll get to that when we talk about the 00:23:54.900 --> 00:23:56.660 adverse effects in a minute, but just that they 00:23:56.660 --> 00:23:58.839 do have more adverse effects associated with 00:23:58.839 --> 00:24:01.680 them. And as you famously say, if there are no 00:24:01.680 --> 00:24:04.519 side effects, then there's no effect. There you 00:24:04.519 --> 00:24:06.660 go. Because something's going to happen in your 00:24:06.660 --> 00:24:09.640 body. So if you're going to alter the concentration 00:24:09.640 --> 00:24:12.519 of neurotransmitters in one area, unfortunately, 00:24:12.579 --> 00:24:14.619 it's not a very specific thing. So it's going 00:24:14.619 --> 00:24:16.119 to go to your body and potentially do something 00:24:16.119 --> 00:24:18.160 else as well. Right. You just have to understand, 00:24:18.279 --> 00:24:22.400 is the trade -off worth it? I forgot to mention 00:24:22.400 --> 00:24:26.299 too, there's now a newer third kind of class 00:24:26.299 --> 00:24:29.220 of drugs that also affect serotonin. They are 00:24:29.220 --> 00:24:36.180 the SSRI serotonin 1A receptor partial agonists. 00:24:36.180 --> 00:24:39.240 So they not only are they reuptake inhibitors, 00:24:39.339 --> 00:24:42.480 but they actually also serve as kind of a partial 00:24:42.480 --> 00:24:45.740 agonist on the receptor. So I believe that that's 00:24:45.740 --> 00:24:48.740 going to like enhance the production of serotonin. 00:24:48.960 --> 00:24:52.160 You know what's a great serotonin 2A agonist? 00:24:53.599 --> 00:24:59.240 Psilocybin. Do you know what that is? I do, but 00:24:59.240 --> 00:25:01.700 what is that? It's the ingredient in magic mushrooms. 00:25:02.160 --> 00:25:06.980 Oh, no. No, no, no. No, son. No, no, no. No, 00:25:07.000 --> 00:25:08.980 no, no. Yeah, we could have a whole podcast on 00:25:08.980 --> 00:25:10.839 that. Oh, Lord have mercy. Please, no. For some 00:25:10.839 --> 00:25:14.599 reason. So this could be a whole tangent, but 00:25:14.599 --> 00:25:19.200 I might even cut this out. But it's like. I remember 00:25:19.200 --> 00:25:20.960 my mom and I had a discussion of this when we 00:25:20.960 --> 00:25:25.380 were in France. And I see no difference in something 00:25:25.380 --> 00:25:28.880 like that because it's just a drug and it's activating 00:25:28.880 --> 00:25:31.319 a certain receptor. Yes, but it's not, you can't, 00:25:31.319 --> 00:25:35.559 the dose is not regulated. And so you could end 00:25:35.559 --> 00:25:37.759 up getting really sick, you know, and stuff. 00:25:37.819 --> 00:25:40.099 It depends because if you're just taking mushrooms 00:25:40.099 --> 00:25:42.740 willy -nilly, I totally agree. Yeah. But now 00:25:42.740 --> 00:25:44.900 you can isolate psilocybin. They've done clinical 00:25:44.900 --> 00:25:47.660 trials on this. Um, and you're trying to figure 00:25:47.660 --> 00:25:49.819 out the dose that gives you the proper benefit. 00:25:50.000 --> 00:25:52.420 So there, I promise you there are actually clinical 00:25:52.420 --> 00:25:54.920 trials. I believe you. I believe you. So if you 00:25:54.920 --> 00:25:57.539 find this, this, you know, fungus, please do 00:25:57.539 --> 00:26:00.980 not, you know, promote this. It's not FDA approved. 00:26:01.160 --> 00:26:03.500 You know, I agree. I'm not, I'm not, I'm not 00:26:03.500 --> 00:26:06.579 saying don't do it. Um, you just gave people 00:26:06.579 --> 00:26:08.960 like new ideas and stuff. I'm like, that might 00:26:08.960 --> 00:26:11.500 not be good. What I'm saying is that it's mechanism 00:26:11.500 --> 00:26:15.700 of action. is, uh, it's a, it's a serotonin to 00:26:15.700 --> 00:26:17.940 a agonist, meaning that one of the reasons why 00:26:17.940 --> 00:26:20.420 it feels so good to take this substance, which 00:26:20.420 --> 00:26:22.940 I have taken, you know, just for record, it's 00:26:22.940 --> 00:26:26.019 like, is because it acts very strongly on, on 00:26:26.019 --> 00:26:28.099 these receptors. So anyways, it involves serotonin. 00:26:28.119 --> 00:26:30.640 That's the whole, the whole thing. So if we have 00:26:30.640 --> 00:26:33.339 this drug or this, this fungus that essentially 00:26:33.339 --> 00:26:35.920 could provide us this compound that we could. 00:26:36.460 --> 00:26:38.539 find the proper dose for it. I said, you should 00:26:38.539 --> 00:26:41.099 see the look on my mom's face. She's just thinking 00:26:41.099 --> 00:26:42.900 that I'm this huge drug. Well, I remember you 00:26:42.900 --> 00:26:44.680 talking about that. It's like, it's like, like 00:26:44.680 --> 00:26:47.019 it took you a day to get over taking it the first 00:26:47.019 --> 00:26:49.680 time. Well, it has a very long half -life in 00:26:49.680 --> 00:26:52.920 your body. And like you said, if you just take 00:26:52.920 --> 00:26:54.740 a mushroom cap, you don't know how much you're 00:26:54.740 --> 00:26:57.700 taking, which is the huge risk. Yeah. Um, luckily 00:26:57.700 --> 00:27:00.079 it's an, it's a biological organism. So you're 00:27:00.079 --> 00:27:03.349 not really like. really having to deal with people 00:27:03.349 --> 00:27:05.410 messing with it you know what i mean like if 00:27:05.410 --> 00:27:09.630 you take something like um gosh lsd or um uh 00:27:09.630 --> 00:27:13.549 what's another ecstasy um which is mdma like 00:27:13.880 --> 00:27:15.900 potentially that can get laced with other chemicals 00:27:15.900 --> 00:27:17.759 and that's actually been a lot of the things 00:27:17.759 --> 00:27:19.720 associated that cause people and the fentanyl 00:27:19.720 --> 00:27:21.599 and you know yeah people will put fentanyl in 00:27:21.599 --> 00:27:24.079 mdma and heroin they're just packing it in yeah 00:27:24.079 --> 00:27:26.480 so but you can't really do that with a mushroom 00:27:26.480 --> 00:27:29.700 which is nice um so um anyways we're getting 00:27:29.700 --> 00:27:33.619 off topic yeah really okay yeah okay well anyway 00:27:33.619 --> 00:27:39.059 okay there you go okay so um and Let's get and 00:27:39.059 --> 00:27:42.599 getting back on target. So I just wanted to just 00:27:42.599 --> 00:27:46.759 give just kind of a just a brief list of all 00:27:46.759 --> 00:27:50.099 of the different indications for which SSRIs 00:27:50.099 --> 00:27:55.500 are used. Again, I'm going to do it in. alphabetical 00:27:55.500 --> 00:27:59.140 order. This is not necessarily, because not all 00:27:59.140 --> 00:28:02.220 of the SSRIs are approved for all of these indications. 00:28:02.500 --> 00:28:07.539 So we've got bipolar major depression, so fluoxetine 00:28:07.539 --> 00:28:10.920 or Prozac is indicated for that. Bulimia, interestingly, 00:28:11.259 --> 00:28:18.220 is also a Prozac indication. A generalized anxiety 00:28:18.220 --> 00:28:21.940 disorder has several of them, Lexapro, Paxil. 00:28:23.480 --> 00:28:26.980 and then the SNRIs, duloxetine, which is Cymbalta, 00:28:27.039 --> 00:28:30.559 and venlafaxine, which is Effexor. Generalized, 00:28:30.579 --> 00:28:33.039 oh, I just said that. Major depressive disorder, 00:28:33.299 --> 00:28:37.460 all of them except for fluvoxamine. Fluvoxamine 00:28:37.460 --> 00:28:41.880 is an older SSRIs, and it's only indicated for 00:28:41.880 --> 00:28:46.259 obsessive -compulsive disorder. We also have... 00:28:46.940 --> 00:28:50.900 the SSRIs that have been used in menopausal vasomotor 00:28:50.900 --> 00:28:54.440 symptoms as well as premenstrual dysphoric disorder. 00:28:54.619 --> 00:28:57.259 And they've been shown to help women to be able 00:28:57.259 --> 00:29:00.140 to stabilize their emotions as they go through 00:29:00.140 --> 00:29:04.279 those points of life. Like when they're pregnant? 00:29:04.900 --> 00:29:08.660 Well, no, no, no. Menopausal, so when you go 00:29:08.660 --> 00:29:12.279 through menopause, you can have a lot of crazy 00:29:12.279 --> 00:29:16.230 hot flashes and stuff like that. I don't know 00:29:16.230 --> 00:29:18.849 how to turn that off, Josh. It's my phone downstairs. 00:29:19.049 --> 00:29:28.630 It's my phone. Thank you. Women have, you know, 00:29:28.630 --> 00:29:32.390 hot flashes and mood changes and stuff. And so 00:29:32.390 --> 00:29:34.849 SSRIs have helped to stabilize that because some 00:29:34.849 --> 00:29:37.089 women can get it really significantly and it 00:29:37.089 --> 00:29:39.690 really affects their quality of life. I mean, 00:29:39.710 --> 00:29:43.750 we all can have it, some worse than others. Pre 00:29:43.750 --> 00:29:45.609 -menstrual dysphoric disorder is the same as 00:29:45.609 --> 00:29:46.950 like when women are going to have their menstrual 00:29:46.950 --> 00:29:50.150 cycle each month. Some of them get really bad 00:29:50.150 --> 00:29:53.849 emotional symptoms that go along with them. And 00:29:53.849 --> 00:29:57.170 so to stabilize that, then they can take a drug 00:29:57.170 --> 00:29:59.950 that is helpful with that. And that's primarily... 00:30:02.309 --> 00:30:04.349 Prozac, Paxil, and Zoloft have been shown to 00:30:04.349 --> 00:30:08.289 work in those conditions or in that particular 00:30:08.289 --> 00:30:11.609 condition. SSRIs have also been used in panic 00:30:11.609 --> 00:30:14.769 disorder, and they've been used in social anxiety 00:30:14.769 --> 00:30:19.549 disorder as well as if you have... Fluoxetine 00:30:19.549 --> 00:30:21.930 has also been FDA approved to be used in treatment 00:30:21.930 --> 00:30:24.569 -resistant depression. So you've got, you know, 00:30:24.589 --> 00:30:27.509 like, you know, it's a variety of different mental 00:30:27.509 --> 00:30:31.210 health issues that these SSRIs over time have 00:30:31.210 --> 00:30:33.730 been found to be safe and effective to be used. 00:30:38.450 --> 00:30:41.970 Like Joshua alluded to, and like we've talked 00:30:41.970 --> 00:30:44.980 about, there's pretty much... not really a medication 00:30:44.980 --> 00:30:46.759 that you can take that doesn't have adverse effects 00:30:46.759 --> 00:30:49.920 associated with it. And so SSRIs can touch a 00:30:49.920 --> 00:30:55.059 lot of your different biological systems, gastrointestinal, 00:30:55.059 --> 00:30:57.579 and some patients that can cause a decreased 00:30:57.579 --> 00:30:59.740 appetite. So you may lose a few pounds when you 00:30:59.740 --> 00:31:02.200 take them. You can have, you know, the typical 00:31:02.200 --> 00:31:04.839 nausea, vomiting, diarrhea, but they're not, 00:31:04.940 --> 00:31:07.519 it's not like a daily type thing, but it's just 00:31:07.519 --> 00:31:11.029 some patients may struggle with that. You can 00:31:11.029 --> 00:31:13.089 have central nervous system effects like drowsiness 00:31:13.089 --> 00:31:15.869 or dizziness. You can have some cardiovascular 00:31:15.869 --> 00:31:18.309 effects like palpitations, like your heart beats 00:31:18.309 --> 00:31:21.289 a little faster, but it's not like the tricyclic 00:31:21.289 --> 00:31:23.329 antidepressants where they really do have cardiac 00:31:23.329 --> 00:31:26.589 dysrhythmias associated with them. One thing 00:31:26.589 --> 00:31:30.859 that can happen with... uh ssris is something 00:31:30.859 --> 00:31:33.319 called that you they can cause a lowering in 00:31:33.319 --> 00:31:36.140 your sodium concentrations which is not always 00:31:36.140 --> 00:31:38.180 great you feel pretty you can get feel pretty 00:31:38.180 --> 00:31:41.319 sick when your sodium levels drop sometimes you 00:31:41.319 --> 00:31:45.339 can get low sodium if you've had like a uh a 00:31:45.339 --> 00:31:48.200 gastrointestinal illness, you know, so your fluids, 00:31:48.400 --> 00:31:51.359 you get dehydrated and stuff. But this is a condition 00:31:51.359 --> 00:31:54.000 also that's associated with SSRIs called syndrome 00:31:54.000 --> 00:31:57.259 of inappropriate antidiuretic hormone, which 00:31:57.259 --> 00:32:01.259 is, it means that the hormone vasopressin, which 00:32:01.259 --> 00:32:04.539 is your antidiuretic hormone, gets increased. 00:32:04.740 --> 00:32:07.720 And so what that means is that you are not able 00:32:07.720 --> 00:32:10.279 to get rid of fluid as much out of your body. 00:32:10.319 --> 00:32:17.400 So think about it. If you have if you've got 00:32:17.400 --> 00:32:23.059 you've got a beaker or a glass of of of water 00:32:23.059 --> 00:32:26.880 and you put some salt in it. And so you've got 00:32:26.880 --> 00:32:29.900 this concentration of salt and water in it. But 00:32:29.900 --> 00:32:33.059 let's say you add more water to it. So now your 00:32:33.059 --> 00:32:35.519 salt concentration is a lot less than that cup. 00:32:35.680 --> 00:32:37.980 That's what happens inside of our body with this 00:32:37.980 --> 00:32:42.029 condition. And so it can be. serious. And so 00:32:42.029 --> 00:32:47.049 it's more likely to occur in elderly patients, 00:32:47.190 --> 00:32:49.750 those that are taking diuretics, which are those 00:32:49.750 --> 00:32:51.829 drugs that are used a lot of times for blood 00:32:51.829 --> 00:32:54.450 pressure that cause you to pee a lot out. And 00:32:54.450 --> 00:32:56.210 then it also could happen with people like I 00:32:56.210 --> 00:32:58.390 talked about that are dehydrated or whatever. 00:32:58.509 --> 00:33:00.329 So you just have to just know about that and 00:33:00.329 --> 00:33:03.049 to be able to use the drug wisely and stuff. 00:33:03.250 --> 00:33:05.250 Yeah. I think a lot of times people associate 00:33:05.250 --> 00:33:09.890 sodium with table salt and then having high sodium, 00:33:09.950 --> 00:33:13.220 which can lead to high blood pressure right um 00:33:13.220 --> 00:33:17.539 but for anybody who remembers their basic cell 00:33:17.539 --> 00:33:20.039 biology um and if they didn't i'm going to remind 00:33:20.039 --> 00:33:23.500 you that there every cell in your body has this 00:33:23.500 --> 00:33:28.720 thing called a sodium potassium pump which essentially 00:33:28.720 --> 00:33:35.079 is you exchange sodium and potassium so that 00:33:35.079 --> 00:33:38.160 you can create a kind of an electric gradient 00:33:38.910 --> 00:33:42.329 to provide energy for the cell so that things 00:33:42.329 --> 00:33:45.730 can come in and out of the cell so sodium is 00:33:45.730 --> 00:33:48.890 just an essential element that your body needs 00:33:48.890 --> 00:33:51.930 and all of your cells need in order just to just 00:33:51.930 --> 00:33:55.710 function and luckily your body is an extremely 00:33:55.710 --> 00:33:58.769 fine -tuned machine that usually regulates that 00:33:58.769 --> 00:34:03.109 balance really well but like mom said too much 00:34:03.109 --> 00:34:06.910 of it can cause a certain too low of it can cause 00:34:06.910 --> 00:34:08.190 a certain condition. If you don't have enough 00:34:08.190 --> 00:34:10.269 sodium, you're not going to be able to pump as 00:34:10.269 --> 00:34:12.789 much back and forth between those cell membranes. 00:34:13.070 --> 00:34:15.309 So it can lead to a lot of these. A lot of things, 00:34:15.369 --> 00:34:20.010 muscle cramping, I think, nausea and vomiting, 00:34:20.269 --> 00:34:23.590 feeling weak. You feel sick when you have a low 00:34:23.590 --> 00:34:25.550 sodium. You clear too much from your body, like 00:34:25.550 --> 00:34:27.670 mom said, especially along with these diuretics. 00:34:28.570 --> 00:34:31.750 Yeah, like mom said, as you get older, more things 00:34:31.750 --> 00:34:35.110 can break down. And so you just need more medications 00:34:35.110 --> 00:34:38.510 to counter a lot of those things that are happening. 00:34:38.630 --> 00:34:41.610 And some of those drug interactions can be a 00:34:41.610 --> 00:34:43.190 little tricky, which is why it's good to have 00:34:43.190 --> 00:34:46.789 a good physician or pharmacist who can help you 00:34:46.789 --> 00:34:48.750 out with that. You're tailoring your dosages 00:34:48.750 --> 00:34:51.510 for these medications for the specific patient. 00:34:53.019 --> 00:34:55.840 Other adverse effects associated with SSRIs are 00:34:55.840 --> 00:34:58.760 you can have a little agitation, but it's not 00:34:58.760 --> 00:35:02.280 like in 50 % of patients. One thing that we need 00:35:02.280 --> 00:35:06.179 to note is that in antidepressants, it's been 00:35:06.179 --> 00:35:10.159 shown in clinical trials that suicidal thoughts 00:35:10.159 --> 00:35:14.920 increase in younger patients, in kiddos, and 00:35:14.920 --> 00:35:17.940 in young adults. So you've got to be... cautious 00:35:17.940 --> 00:35:20.320 about that they may need the antidepressant but 00:35:20.320 --> 00:35:22.420 they just need you they've got there's needs 00:35:22.420 --> 00:35:25.400 to be an awareness of suicidal thoughts and those 00:35:25.400 --> 00:35:28.760 and there may be other treatments uh non -pharmacologic 00:35:28.760 --> 00:35:30.320 treatments we'll talk about in a little bit that 00:35:30.320 --> 00:35:33.679 may be more useful in those patient populations 00:35:33.679 --> 00:35:38.039 um initially at least anyway um and another interesting 00:35:38.039 --> 00:35:41.340 thing is because serotonin like josh said is 00:35:41.340 --> 00:35:45.679 in all cells it's also in your platelets and 00:35:45.679 --> 00:35:49.440 um you and and so um you can have some blood 00:35:49.440 --> 00:35:53.539 effects adverse blood of blood effects from taking 00:35:53.539 --> 00:35:58.300 ssris and not this is not a common this is infrequent 00:35:58.300 --> 00:36:01.679 and rare but your platelets might get depleted 00:36:01.679 --> 00:36:04.000 of serotonin because you've got the remember 00:36:04.000 --> 00:36:06.199 we've got the inhibitor blocking and it's not 00:36:06.199 --> 00:36:08.239 it may not be getting to all the places that 00:36:08.239 --> 00:36:11.019 it's supposed to be getting to so if you have 00:36:11.670 --> 00:36:14.949 If your platelets don't work properly, remember 00:36:14.949 --> 00:36:18.909 we use platelets to help clot our blood, like 00:36:18.909 --> 00:36:21.989 if we cut ourself and stuff. And so if you don't 00:36:21.989 --> 00:36:23.690 have that working correctly, then you could have 00:36:23.690 --> 00:36:26.090 increased bleeding risk. And it's okay if, I 00:36:26.090 --> 00:36:28.969 mean, you know, we can see the external times 00:36:28.969 --> 00:36:31.449 when we cut ourselves, like if we like slice 00:36:31.449 --> 00:36:34.690 our finger with a knife, but we could also not 00:36:34.690 --> 00:36:36.909 be able to see things that are happening inside. 00:36:36.969 --> 00:36:39.210 Like, and so one of the big... problems could 00:36:39.210 --> 00:36:41.289 potentially be gastrointestinal bleeding that 00:36:41.289 --> 00:36:45.210 you can't necessarily see. So you just, you know, 00:36:45.210 --> 00:36:48.309 so again, it's just, it's not a common thing, 00:36:48.389 --> 00:36:51.690 but I'm just making people aware that that has 00:36:51.690 --> 00:36:54.190 been seen with this particular drug class. Also 00:36:54.190 --> 00:36:57.250 too, if you are taking a drug that also increases 00:36:57.250 --> 00:37:00.969 bleeding risk, like an anticoagulant, it's not 00:37:00.969 --> 00:37:03.090 that you can't take these two medications together, 00:37:03.250 --> 00:37:05.710 but you just have to be cognizant of what's going 00:37:05.710 --> 00:37:08.860 on. Yeah, that's a really good point. Two other 00:37:08.860 --> 00:37:10.340 things I want to talk about as far as adverse 00:37:10.340 --> 00:37:13.719 effects. This is probably one of the bigger complaints 00:37:13.719 --> 00:37:17.559 of taking SSRIs and that they have effects on 00:37:17.559 --> 00:37:21.920 your sexual function. And that is, there's been 00:37:21.920 --> 00:37:24.400 some interesting thought as to why that happens. 00:37:24.480 --> 00:37:29.480 It might be because your mood is kind of more... 00:37:30.269 --> 00:37:32.469 flattened per se than where you were before, 00:37:32.789 --> 00:37:36.210 but sometimes it might make you not feel, it 00:37:36.210 --> 00:37:41.820 may dull emotional pain, but it may also. flatten 00:37:41.820 --> 00:37:45.539 out your more excitement type and joy field type 00:37:45.539 --> 00:37:48.099 things and stuff, which may have an effect on 00:37:48.099 --> 00:37:50.300 sexual function because of all what goes on in 00:37:50.300 --> 00:37:54.739 a sexual relationship. But that's just part of 00:37:54.739 --> 00:37:57.739 it and stuff. And I apologize, but I don't know 00:37:57.739 --> 00:38:01.500 the whole mechanism behind serotonin and sexual 00:38:01.500 --> 00:38:04.639 function. Yeah, it's a good point. I mean, it's 00:38:04.639 --> 00:38:06.920 like, because you also mentioned too that it 00:38:06.920 --> 00:38:10.269 can affect. fluid retention in the prostate, 00:38:10.469 --> 00:38:12.909 right? Which could potentially cause - No, those 00:38:12.909 --> 00:38:15.670 are tricyclic antidepressants. Oh, sorry. So 00:38:15.670 --> 00:38:18.590 not any of the - Yeah. Yeah. I mean, that makes 00:38:18.590 --> 00:38:21.250 a lot of sense, but it is definitely an issue 00:38:21.250 --> 00:38:23.309 that goes along with these, some more than others. 00:38:23.369 --> 00:38:25.710 So again, if it's happening with one of your 00:38:25.710 --> 00:38:28.590 particular SSRIs, then you could switch to another 00:38:28.590 --> 00:38:31.250 one and possibly, you know, yeah. And it's, it's 00:38:31.250 --> 00:38:33.190 really patient dependent and patient specific. 00:38:33.309 --> 00:38:34.849 Yeah. It's almost kind of like, is it affecting 00:38:34.849 --> 00:38:37.769 the software or the hardware pun intended, but 00:38:37.769 --> 00:38:41.090 it's like the, the idea is like, yeah. And it's 00:38:41.090 --> 00:38:42.789 like, yeah. It'd be like, yeah. If you can't 00:38:42.789 --> 00:38:46.929 get aroused, right. But maybe mentally, or is 00:38:46.929 --> 00:38:49.489 it, actually physically right um you're right 00:38:49.489 --> 00:38:50.949 it probably does depend on the patient right 00:38:50.949 --> 00:38:53.429 and so it could be it can be a reason why people 00:38:53.429 --> 00:38:56.170 don't want to take ssris yeah but it doesn't 00:38:56.170 --> 00:38:58.829 happen in 100 of patients but again it's just 00:38:58.829 --> 00:39:01.349 something to be aware of and one other thing 00:39:01.349 --> 00:39:03.550 that's really important as well too that because 00:39:03.550 --> 00:39:06.590 these are serotonin selective serotonin reuptake 00:39:06.590 --> 00:39:09.530 inhibitors there's a rare but potentially fatal 00:39:10.710 --> 00:39:13.750 reaction called serotonin syndrome that can occur. 00:39:13.869 --> 00:39:16.949 And it happens to, and it's due to serotonergic 00:39:16.949 --> 00:39:19.989 overactivity. So if you have too much serotonin, 00:39:19.989 --> 00:39:22.449 then you can have nausea, vomiting, excess sweating, 00:39:22.630 --> 00:39:25.690 dizziness, facial flushing, mental status changes, 00:39:25.949 --> 00:39:29.530 elevated blood pressure. So it's serious. So 00:39:29.530 --> 00:39:31.389 if you started having any of those feelings, 00:39:31.469 --> 00:39:33.889 you would need to contact your healthcare provider 00:39:33.889 --> 00:39:39.900 immediately. One other thing that's noteworthy 00:39:39.900 --> 00:39:43.820 about SSRIs, pretty much other antidepressants 00:39:43.820 --> 00:39:46.159 as well too, is that you want to taper them off. 00:39:46.199 --> 00:39:49.260 You don't want to abruptly discontinue them or 00:39:49.260 --> 00:39:52.119 you might trigger a withdrawal syndrome. So if 00:39:52.119 --> 00:39:54.329 you're starting to feel better. Quote unquote, 00:39:54.530 --> 00:39:56.809 if you're feeling less depressive symptoms, you 00:39:56.809 --> 00:39:58.989 might think, I don't need this SSRI anymore. 00:39:59.469 --> 00:40:02.170 And somebody might want to go off cold turkey. 00:40:02.349 --> 00:40:05.530 Or the other way. This isn't working. I want 00:40:05.530 --> 00:40:07.889 to stop it. But if you've been taking it for 00:40:07.889 --> 00:40:10.889 a month, you still need to taper off the dose. 00:40:10.969 --> 00:40:13.309 Yeah, so just key is to taper no matter what. 00:40:13.599 --> 00:40:16.380 Okay. That's good advice. One other thing I want 00:40:16.380 --> 00:40:18.380 to mention as far as adverse effects compared 00:40:18.380 --> 00:40:21.840 to other agents are concerned. So tricyclic antidepressants, 00:40:21.860 --> 00:40:24.179 like I said, they used to have, I'm not used 00:40:24.179 --> 00:40:26.659 to, they have cardiac dysrhythmias associated 00:40:26.659 --> 00:40:29.480 with them as well as these anticholinergic effects, 00:40:29.619 --> 00:40:37.840 which can cause, you know, scratch a dry throat 00:40:37.840 --> 00:40:42.400 or urinary, urine retention, that type constipation. 00:40:43.300 --> 00:40:46.500 But because there can be an increased suicidal 00:40:46.500 --> 00:40:50.719 risk with depressed patients, people have been 00:40:50.719 --> 00:40:53.380 known to use tricyclics to try to overdose on. 00:40:53.480 --> 00:40:55.480 And because of those cardiac effects, they can 00:40:55.480 --> 00:40:57.320 get really sick and they can kill themselves. 00:40:57.559 --> 00:41:01.420 So it's just something to be aware of. Yeah, 00:41:01.420 --> 00:41:04.500 that's a good point. Also, another famous MAOI 00:41:04.500 --> 00:41:08.960 or monoamine oxidase inhibitor is cocaine. And 00:41:08.960 --> 00:41:12.139 one of the bad things about cocaine is that it 00:41:12.139 --> 00:41:14.380 can arrest your heart. And one of the reasons 00:41:14.380 --> 00:41:16.599 why that is, is because of the same reason as 00:41:16.599 --> 00:41:19.210 the tricyclics and things like that. Right. And 00:41:19.210 --> 00:41:21.909 the other thing about MAOI inhibitors is that 00:41:21.909 --> 00:41:25.130 they can also interact with foods like these 00:41:25.130 --> 00:41:28.650 foods that are high in tyramine. So you're talking 00:41:28.650 --> 00:41:34.849 about avocados, bananas, beer, and cheddar and 00:41:34.849 --> 00:41:38.030 aged cheeses. And they can interfere and they 00:41:38.030 --> 00:41:40.949 can increase, they can, because the monoamine, 00:41:41.929 --> 00:41:44.769 oxidase inhibitors are increasing concentrations 00:41:44.769 --> 00:41:47.849 of norepinephrine and epinephrine and dopamine 00:41:47.849 --> 00:41:49.949 in your synapses. I believe that these agents 00:41:49.949 --> 00:41:53.190 also can increase norepinephrine with this interaction. 00:41:53.570 --> 00:41:57.190 As well as there's a lot of other foods that 00:41:57.190 --> 00:41:58.769 interact as well too. And there's other medications 00:41:58.769 --> 00:42:02.090 that also can interact. So you need any medications 00:42:02.090 --> 00:42:05.670 that increase serotonin or norepinephrine, using 00:42:05.670 --> 00:42:08.010 them together can make you really sick. So you've 00:42:08.010 --> 00:42:10.070 got, there's a lot of contraindications for use 00:42:10.070 --> 00:42:13.079 with MAOIs. That makes sense. And like anything, 00:42:13.420 --> 00:42:16.179 the dose makes the poison. It does. So just depending 00:42:16.179 --> 00:42:18.760 on your diet and obviously your ability to digest 00:42:18.760 --> 00:42:21.739 and metabolize certain things, it's obviously 00:42:21.739 --> 00:42:23.500 going to be patient dependent. So you're just 00:42:23.500 --> 00:42:25.519 going to kind of notice this as you take this. 00:42:25.619 --> 00:42:29.599 Your pharmacist will probably counsel you not 00:42:29.599 --> 00:42:32.559 to be using particular medications or eat particular 00:42:32.559 --> 00:42:35.820 foods. But you do have to be careful. Over time, 00:42:35.940 --> 00:42:37.659 you might be able to figure, well, I can do this 00:42:37.659 --> 00:42:40.619 amount of cheese, whatever I can have. a fourth 00:42:40.619 --> 00:42:42.719 of a beer, you know, but it just, it's not like 00:42:42.719 --> 00:42:44.320 he, like Josh said, it's really patient dependent. 00:42:44.480 --> 00:42:46.840 I know a lot of people when they hear the side 00:42:46.840 --> 00:42:49.480 effects on pharmaceutical commercials, they're 00:42:49.480 --> 00:42:53.559 just like, oh my gosh, that's so much. And I 00:42:53.559 --> 00:42:56.420 think, I guess I would love for you to speak 00:42:56.420 --> 00:42:58.619 to the idea of like, I think sometimes a lot 00:42:58.619 --> 00:43:02.840 of side effects can scare people off. I think 00:43:02.840 --> 00:43:06.039 a lot of people might think that this is always 00:43:06.039 --> 00:43:08.780 going to happen. Like when you take this drug, 00:43:09.389 --> 00:43:12.010 like these things are going to happen. So would 00:43:12.010 --> 00:43:14.050 you mind just kind of giving a brief overview 00:43:14.050 --> 00:43:17.309 of when side effects are discussed, like how 00:43:17.309 --> 00:43:19.650 they were discovered in the first place and then 00:43:19.650 --> 00:43:22.869 why they're mentioned? Well, when you do clinical 00:43:22.869 --> 00:43:26.090 trials for a medication, one of the things that 00:43:26.090 --> 00:43:30.309 has to be evaluated is safety. as well as efficacy. 00:43:30.590 --> 00:43:32.989 So we certainly want the medication to work, 00:43:33.130 --> 00:43:35.090 but we also want it to be safe. And so you're 00:43:35.090 --> 00:43:37.389 looking for adverse effects that could potentially 00:43:37.389 --> 00:43:40.789 be deal killers. And so they're going to capture, 00:43:40.929 --> 00:43:42.670 you know, all kinds of things because they're 00:43:42.670 --> 00:43:44.889 looking at all of your organ systems to see whether 00:43:44.889 --> 00:43:47.489 or not the drug is going to have an adverse impact 00:43:47.489 --> 00:43:52.170 on those. And so then not only do you look to 00:43:52.170 --> 00:43:54.409 see what... potentially can happen, but then 00:43:54.409 --> 00:43:57.710 you also quantify it based on how many people 00:43:57.710 --> 00:44:01.050 did this actually happen in. And so in package 00:44:01.050 --> 00:44:04.210 inserts for medications, or you can look things 00:44:04.210 --> 00:44:07.309 up online for particular medications, you'll 00:44:07.309 --> 00:44:10.550 oftentimes see it associated with different percentages. 00:44:10.869 --> 00:44:14.769 So adverse effects are that you'll list the most 00:44:14.769 --> 00:44:16.789 common adverse effects, but then you're going 00:44:16.789 --> 00:44:20.389 to list some rarer ones as well too. The pharmaceutical 00:44:20.389 --> 00:44:23.929 manufacturer is required to disclose that information 00:44:23.929 --> 00:44:28.050 just so that patients know that. Here it all 00:44:28.050 --> 00:44:30.190 is, you know, and stuff. Now, no, it does not 00:44:30.190 --> 00:44:31.730 mean you're going to get every, nobody's going 00:44:31.730 --> 00:44:33.429 to get every single adverse effect that's listed 00:44:33.429 --> 00:44:35.809 in a package insert. But there could be some 00:44:35.809 --> 00:44:38.550 that are just more common for people. Like, for 00:44:38.550 --> 00:44:41.250 example, if you take an antibiotic, maybe you're 00:44:41.250 --> 00:44:43.070 going to feel a little upset stomach. And we 00:44:43.070 --> 00:44:45.309 may all feel that. But it doesn't mean we stop 00:44:45.309 --> 00:44:47.369 the antibiotic. We're able to get through it 00:44:47.369 --> 00:44:50.750 or whatever and stuff. So, but you just have 00:44:50.750 --> 00:44:53.210 to know that they are, and I did not include 00:44:53.210 --> 00:44:55.809 percentages for all these adverse effects I just 00:44:55.809 --> 00:44:59.179 talked about. a lot of them are really not common. 00:44:59.739 --> 00:45:02.760 You know, maybe, you know, the decreased appetite 00:45:02.760 --> 00:45:05.880 might happen in 20 % of patients and stuff, but 00:45:05.880 --> 00:45:08.599 it doesn't happen in 100 % of patients. All those 00:45:08.599 --> 00:45:11.420 adverse effects did not happen in 100 % of patients. 00:45:11.659 --> 00:45:14.059 There's scales as far as how frequently they 00:45:14.059 --> 00:45:16.739 happen. Usually you'll target the ones that are 00:45:16.739 --> 00:45:20.400 more common and then you'll go down to, we start 00:45:20.400 --> 00:45:22.519 looking at the ones that are less common if somebody 00:45:22.519 --> 00:45:24.719 starts complaining of something and you'll think, 00:45:24.880 --> 00:45:27.099 I wonder if this medication. can cause this as 00:45:27.099 --> 00:45:29.119 well too. And so then you start looking for that 00:45:29.119 --> 00:45:31.199 as well. It almost makes me think it would be 00:45:31.199 --> 00:45:33.519 a really interesting, just like the way that 00:45:33.519 --> 00:45:36.539 we compare the drug to a placebo to determine 00:45:36.539 --> 00:45:38.380 its effectiveness. It would be interesting to 00:45:38.380 --> 00:45:42.099 compare the side effects between placebo and 00:45:42.099 --> 00:45:45.099 the drug of interest. Oh, they do. Yeah, what 00:45:45.099 --> 00:45:46.539 I mean is that would be an interesting percentage 00:45:46.539 --> 00:45:48.480 to have in the insert. I don't know if that's 00:45:48.480 --> 00:45:50.579 actually in the insert. They do. Because like 00:45:50.579 --> 00:45:53.780 if you have 20 % of people complaining of nausea 00:45:53.780 --> 00:45:56.309 in one group. And then 20 in the other. Right. 00:45:56.409 --> 00:46:02.429 And so if you have the opportunity. You can always 00:46:02.429 --> 00:46:06.289 find a package insert for medications if they're 00:46:06.289 --> 00:46:08.369 not a brand name drug anymore, you know, that 00:46:08.369 --> 00:46:10.769 they've gone generic. You can go to the Food 00:46:10.769 --> 00:46:13.409 and Drug Administration and there's a drug section 00:46:13.409 --> 00:46:15.329 there and you can actually pull a package insert. 00:46:15.429 --> 00:46:17.889 So you can just Google the generic name of the 00:46:17.889 --> 00:46:20.329 medication and package insert and you can find 00:46:20.329 --> 00:46:22.730 it. And if you go to the adverse effects section 00:46:22.730 --> 00:46:26.449 of a package insert, you'll see a table there. 00:46:26.590 --> 00:46:29.329 And they're oftentimes comparing it to placebo. 00:46:29.429 --> 00:46:31.610 Sometimes they're comparing it. to other drug 00:46:31.610 --> 00:46:33.610 treatments. It just depends on what the medication 00:46:33.610 --> 00:46:37.969 is. A lot of times with the adverse effects table, 00:46:38.210 --> 00:46:41.809 it's not, there aren't enough numbers of patients 00:46:41.809 --> 00:46:45.110 to do statistical analysis on them, but you can 00:46:45.110 --> 00:46:48.289 see the numbers for yourself to see like, oh, 00:46:48.289 --> 00:46:52.010 there were 22 people in the treatment group and 00:46:52.010 --> 00:46:56.900 20 in the. other groups so this is not necessarily 00:46:56.900 --> 00:46:59.559 roughly the same cause and effect as far as this 00:46:59.559 --> 00:47:01.440 adverse effect is concerned that's a great point 00:47:01.440 --> 00:47:04.179 to bring out as well too josh so yeah it's unfortunate 00:47:04.179 --> 00:47:06.139 that you have to do a little bit of extra leg 00:47:06.139 --> 00:47:09.119 work just because i know for legal reasons they're 00:47:09.119 --> 00:47:10.780 just going to try to mention that these people 00:47:10.780 --> 00:47:14.059 had side effects I just get the sense, and I 00:47:14.059 --> 00:47:16.139 could be completely wrong, that most people think 00:47:16.139 --> 00:47:18.199 they're just very scared off of certain medications 00:47:18.199 --> 00:47:20.239 because they hear the side effects. It's a common 00:47:20.239 --> 00:47:22.639 trope of like, oh my gosh, the side effects are 00:47:22.639 --> 00:47:24.360 longer on a pharmaceutical commercial. They absolutely 00:47:24.360 --> 00:47:28.000 are, yes. And I know they need to be, but at 00:47:28.000 --> 00:47:30.300 the end of the day, it's like, well, if it's 00:47:30.300 --> 00:47:34.500 just a 1 % extra risk, then I'm willing to take 00:47:34.500 --> 00:47:36.619 that risk to potentially lower my depressive 00:47:36.619 --> 00:47:39.150 symptoms compared to placebo by... You know, 00:47:39.150 --> 00:47:42.349 60 to 70 percent. And I think, you know, you 00:47:42.349 --> 00:47:44.389 know, when I was growing up, we definitely didn't 00:47:44.389 --> 00:47:46.010 have those kinds of commercials and stuff. But 00:47:46.010 --> 00:47:49.809 I think it just it informs patients now. So it 00:47:49.809 --> 00:47:52.210 gives you more material to go to your talk to 00:47:52.210 --> 00:47:53.889 your doctor with or your health care provider 00:47:53.889 --> 00:47:56.530 with. You know, it's like I heard that this causes, 00:47:56.650 --> 00:47:59.809 you know. blank or whatever and you're like and 00:47:59.809 --> 00:48:02.210 they can say well you know what it only happens 00:48:02.210 --> 00:48:04.750 in 0 .1 percent of patients you know and stuff 00:48:04.750 --> 00:48:07.230 so so they can help put some perspective on it 00:48:07.230 --> 00:48:09.230 as well so when you listen to all those commercials 00:48:09.230 --> 00:48:12.010 with all those adverse effects that's a really 00:48:12.010 --> 00:48:14.250 good point yeah and i think if you're ever looking 00:48:14.250 --> 00:48:17.389 for a drug insert it's usually either just uh 00:48:18.599 --> 00:48:21.880 paper that's inside of the the it can be on the 00:48:21.880 --> 00:48:24.559 bottle or a lot of times when you go to your 00:48:24.559 --> 00:48:27.800 pharmacy they will staple that information on 00:48:27.800 --> 00:48:30.099 the outside of your bag and so that has a lot 00:48:30.099 --> 00:48:32.199 of the adverse effects associated with it but 00:48:32.199 --> 00:48:37.519 if you go to like um let's say we go to um vibrid 00:48:37.519 --> 00:48:41.000 which is one of those um s i believe it's an 00:48:41.000 --> 00:48:43.599 snri but i could be completely wrong on that 00:48:43.599 --> 00:48:47.320 let's I'm completely wrong on that. It is one 00:48:47.320 --> 00:48:51.300 of the SSRI 5 -HT1A receptor partial agonists. 00:48:51.300 --> 00:48:55.159 So you go to the Vybrid. And since it's a newer 00:48:55.159 --> 00:48:58.320 medication, you can pull up Vybrid. And you can 00:48:58.320 --> 00:49:01.099 go to the top and it'll say prescribing information. 00:49:01.420 --> 00:49:03.800 And you can click on that and you'll pull up 00:49:03.800 --> 00:49:05.760 the whole package insert. Okay, cool. That's 00:49:05.760 --> 00:49:08.119 good to let people know if they want to be more 00:49:08.119 --> 00:49:09.760 informed. Some light reading before you go to 00:49:09.760 --> 00:49:11.579 bed. Yeah, light reading. You can find out the 00:49:11.579 --> 00:49:13.900 mechanism, all the clinical trials. Think about 00:49:13.900 --> 00:49:15.679 how much you can learn. Yeah, a lot of information. 00:49:16.989 --> 00:49:20.750 So we'll move into, now that we've talked about 00:49:20.750 --> 00:49:23.750 all these adverse effects, now we'll talk about 00:49:23.750 --> 00:49:26.420 treatment adherence, which means like. you know, 00:49:26.420 --> 00:49:28.739 will you continue to take your medication, you 00:49:28.739 --> 00:49:30.579 know, and stuff. So, I mean, there could be a 00:49:30.579 --> 00:49:33.800 variety of reasons why you don't want to continue 00:49:33.800 --> 00:49:35.780 taking the medication. Maybe you've had an adverse 00:49:35.780 --> 00:49:37.940 effect or you feel like it's not doing anything. 00:49:38.300 --> 00:49:40.619 But there's a couple of reasons or there's a 00:49:40.619 --> 00:49:43.480 couple of ways that patients with the mental 00:49:43.480 --> 00:49:47.039 health disorders can be encouraged to stay the 00:49:47.039 --> 00:49:48.599 course with their treatment. And it could be 00:49:48.599 --> 00:49:51.179 that you have a great relationship with your 00:49:51.179 --> 00:49:56.460 healthcare provider or that your attitudes about 00:49:56.460 --> 00:49:58.360 treatment are understood and that you really 00:49:58.360 --> 00:50:01.079 feel like you've been heard as far as how you 00:50:01.079 --> 00:50:03.719 feel. And that you are also, as the patient, 00:50:03.780 --> 00:50:05.920 involved in the treatment decision as far as 00:50:05.920 --> 00:50:11.059 what gets done. Please remember that even though 00:50:11.059 --> 00:50:14.699 the mechanism of an antidepressant, today we're 00:50:14.699 --> 00:50:17.400 talking about SSRIs, can happen pretty quickly, 00:50:17.699 --> 00:50:21.940 the clinical effects from that chemical reaction 00:50:22.889 --> 00:50:25.949 will take several weeks to be seen. So you have 00:50:25.949 --> 00:50:29.389 to be patient with the effects of an antidepressant. 00:50:29.489 --> 00:50:32.989 And so don't, after two weeks, don't say this 00:50:32.989 --> 00:50:34.969 isn't working. You've got to give it several 00:50:34.969 --> 00:50:39.530 weeks to see what happens. That's just, it used 00:50:39.530 --> 00:50:42.210 to be that some of the older antidepressants 00:50:42.210 --> 00:50:45.090 took months. So with the SSRIs just taking weeks, 00:50:45.230 --> 00:50:48.389 it's a lot better than in past times. But you 00:50:48.389 --> 00:50:52.170 do have to give it some time to have effects. 00:50:52.590 --> 00:50:55.690 And so don't be tempted to discontinue your medication 00:50:55.690 --> 00:50:57.389 when you're not seeing what you want. Give it 00:50:57.389 --> 00:51:02.639 at least a month. I've got, and so all those 00:51:02.639 --> 00:51:07.059 treatment, I mean, all those mental health disorders 00:51:07.059 --> 00:51:09.519 that we talked about that SSRIs are used in. 00:51:10.349 --> 00:51:12.449 There are a whole lot of different treatment 00:51:12.449 --> 00:51:15.170 durations for how long SSR should be completed. 00:51:15.590 --> 00:51:18.590 Things like premenstrual dysphoric disorder are 00:51:18.590 --> 00:51:22.369 going to be more sporadic. Maybe a woman needs 00:51:22.369 --> 00:51:25.170 to take it just around the time of her menstrual 00:51:25.170 --> 00:51:26.929 cycle every month, or sometimes they may need 00:51:26.929 --> 00:51:28.610 to take it all the time. It just depends on the 00:51:28.610 --> 00:51:33.389 patient. The vasomotor menopausal symptoms, maybe 00:51:33.389 --> 00:51:37.010 it's temporary because menopause doesn't usually 00:51:37.010 --> 00:51:40.130 last really severely forever, but in some women, 00:51:40.210 --> 00:51:43.570 it does. And so it's going to be patient -specific 00:51:43.570 --> 00:51:45.309 as well, too. You may need help, you know, for 00:51:45.309 --> 00:51:49.329 a longer time period. Bulimia, the recommended 00:51:49.329 --> 00:51:52.510 treatment duration is nine months to a year, 00:51:52.630 --> 00:51:54.449 but again, that's patient -specific, and they 00:51:54.449 --> 00:51:57.469 may need it longer. Post -traumatic stress disorder 00:51:57.469 --> 00:52:00.190 is another reason to take SSRIs, and you may 00:52:00.190 --> 00:52:02.449 need to be treated for up to a year, but it could 00:52:02.449 --> 00:52:05.369 be longer. It depends on the patient. Same thing 00:52:05.369 --> 00:52:09.329 with general... anxiety disorder, obsessive compulsive 00:52:09.329 --> 00:52:11.769 disorder. You may need one to two years after 00:52:11.769 --> 00:52:15.929 you go into remission. Panic disorder, same thing, 00:52:16.150 --> 00:52:19.710 may need up to 24 months of treatment. Major 00:52:19.710 --> 00:52:25.050 depressive disorder. You may need eight to 16 00:52:25.050 --> 00:52:27.590 weeks of acute treatment, but then you may need 00:52:27.590 --> 00:52:31.550 at least 24 months of therapy as you stabilize 00:52:31.550 --> 00:52:34.269 and you may need it longer. And with depression, 00:52:34.590 --> 00:52:37.389 major depressive disorder, what's been found 00:52:37.389 --> 00:52:42.070 is that if you So there could be certain conditions 00:52:42.070 --> 00:52:44.610 that could cause you to have a second bout of 00:52:44.610 --> 00:52:47.369 depression. And the more bouts of depression 00:52:47.369 --> 00:52:50.130 you have, the more likely you are to have another 00:52:50.130 --> 00:52:55.929 bout of depression. So it's a disease that can 00:52:55.929 --> 00:52:58.289 be frustrating, you know, as well, too. But we 00:52:58.289 --> 00:53:01.590 do have a lot of things to be utilized to help 00:53:01.590 --> 00:53:05.250 patients manage that particular disease state. 00:53:12.900 --> 00:53:17.340 So you may have antidepressants continued in 00:53:17.340 --> 00:53:19.840 patients with depression for longer time periods 00:53:19.840 --> 00:53:22.940 just based on that tendency for that particular 00:53:22.940 --> 00:53:26.760 visiting state. Josh also alluded to this as 00:53:26.760 --> 00:53:29.760 far as self -care in depression. And this is 00:53:29.760 --> 00:53:31.960 particularly in depression, but I think that 00:53:31.960 --> 00:53:35.019 it could be applied to other things like generalized 00:53:35.019 --> 00:53:38.840 anxiety disorder, panic disorder, or post -traumatic 00:53:38.840 --> 00:53:41.829 stress disorder as well too. you want to keep 00:53:41.829 --> 00:53:43.809 doing the things that you like to do. Even though 00:53:43.809 --> 00:53:46.250 it feels really hard, you want to do that. And 00:53:46.250 --> 00:53:48.309 you want to stay connected with your friends 00:53:48.309 --> 00:53:50.550 and family instead of isolating because what 00:53:50.550 --> 00:53:53.090 you want to do is isolate. But you have to force 00:53:53.090 --> 00:53:56.869 yourself to say yes to that person who's calling 00:53:56.869 --> 00:53:58.349 you and says that they want to go have coffee 00:53:58.349 --> 00:54:02.699 with you. Exercise on a regular basis, even if 00:54:02.699 --> 00:54:05.039 it's just a short walk. You know, get out there 00:54:05.039 --> 00:54:06.780 and get your heart pumping. It does tend to help 00:54:06.780 --> 00:54:10.219 you feel a little bit better. You want to do 00:54:10.219 --> 00:54:14.500 regular eating and regular sleeping habits. You 00:54:14.500 --> 00:54:16.619 want to kind of try to cut down on your alcohol 00:54:16.619 --> 00:54:19.019 and any type of use of illicit drugs because 00:54:19.019 --> 00:54:23.199 they are also associated with a perpetuating 00:54:23.199 --> 00:54:28.380 depressive state. I think if, yeah. Stepping 00:54:28.380 --> 00:54:31.079 in there is this, okay, so if we're thinking 00:54:31.079 --> 00:54:35.900 about these mental health disorders as an imbalance 00:54:35.900 --> 00:54:39.820 of certain neurotransmitters or chemicals in 00:54:39.820 --> 00:54:44.079 your body, and you are seeking to restore that 00:54:44.079 --> 00:54:49.030 balance, there are many ways to do that. essentially 00:54:49.030 --> 00:54:52.110 you are the sum of a lot of these chemicals in 00:54:52.110 --> 00:54:55.469 your brain to do these behaviors. And a lot of 00:54:55.469 --> 00:54:57.849 times I'll be 38 on Friday. And a lot of times 00:54:57.849 --> 00:55:00.230 I've been doing these behaviors for 38 years. 00:55:00.510 --> 00:55:04.650 So when you are doing these interventions, you 00:55:04.650 --> 00:55:07.409 are essentially just trying to change who you 00:55:07.409 --> 00:55:11.210 are as a person. And there's, we could go into 00:55:11.210 --> 00:55:15.579 a whole another category on this, but The main 00:55:15.579 --> 00:55:18.599 goal of doing anything differently is to try 00:55:18.599 --> 00:55:23.300 to change your brain state. So the way I like 00:55:23.300 --> 00:55:27.320 to think about mental health disorder and using 00:55:27.320 --> 00:55:32.260 things like SSRIs is that when you are in a bout 00:55:32.260 --> 00:55:34.260 of depression, whether it be mild or severe, 00:55:34.559 --> 00:55:38.320 I call that like the fog of war. You are lost 00:55:38.320 --> 00:55:41.849 in the fog. You basically feel like, I don't 00:55:41.849 --> 00:55:43.710 know where to go. I don't know where up, down, 00:55:43.769 --> 00:55:45.889 left, right, or is. I'm just going to sit still 00:55:45.889 --> 00:55:48.570 and do nothing. And the forest could even be 00:55:48.570 --> 00:55:50.570 a round full of enemies or full of maybe even 00:55:50.570 --> 00:55:53.550 on fire. And you literally don't have enough 00:55:53.550 --> 00:55:57.170 information to move. And so you sit still, which 00:55:57.170 --> 00:55:59.010 is probably the opposite of what you should do, 00:55:59.130 --> 00:56:04.130 depending on your circumstance. What I think 00:56:04.130 --> 00:56:07.690 SSRIs are is the lifting of that fog, depending 00:56:07.690 --> 00:56:10.329 on the population. of the person that you're 00:56:10.329 --> 00:56:14.190 in. And then when that fog is lifted, you then 00:56:14.190 --> 00:56:16.769 get a little bit of extra information to be able 00:56:16.769 --> 00:56:19.030 to make different decisions. And if you are a 00:56:19.030 --> 00:56:23.849 cognitively, I'm going to say this, I'm going 00:56:23.849 --> 00:56:26.110 to try to say this in a sensitive way, like a 00:56:26.110 --> 00:56:28.449 cognitively prepared person, meaning that you 00:56:28.449 --> 00:56:31.710 have good, you have self -esteem, you've got 00:56:31.710 --> 00:56:34.369 good social skills, you have ability to cope 00:56:34.369 --> 00:56:37.610 with bad things happening in your life, then 00:56:37.610 --> 00:56:39.449 you'll be able to navigate out of that forest 00:56:39.449 --> 00:56:42.110 because you have the skills and you've just lifted 00:56:42.110 --> 00:56:45.349 your depression to kind of trap you in. If you're 00:56:45.349 --> 00:56:49.510 a person who has maladaptive strategies, even 00:56:49.510 --> 00:56:53.130 if you lift that fog of war, you might just run 00:56:53.130 --> 00:56:55.550 towards the fire because that is what you know. 00:56:55.650 --> 00:56:58.889 There are people born in this world who are addicted 00:56:58.889 --> 00:57:03.389 to pain because they see pain as just a way to 00:57:03.389 --> 00:57:06.619 signify that they're alive. Or they go towards 00:57:06.619 --> 00:57:09.139 abuse because they've associated abuse with love. 00:57:09.500 --> 00:57:12.699 And the reason I'm saying all this is because 00:57:12.699 --> 00:57:18.019 this is a good way to think. SSRs aren't going 00:57:18.019 --> 00:57:20.139 to solve your problems. They're a tool to help 00:57:20.139 --> 00:57:23.099 lessen symptoms. And if you're really looking 00:57:23.099 --> 00:57:26.139 to change your life in a way that's going to 00:57:26.139 --> 00:57:28.699 be pretty profound, one of the ways that's been 00:57:28.699 --> 00:57:32.300 really shown is... cognitive behavioral therapy, 00:57:32.500 --> 00:57:38.739 which is essentially a long -term, it's a long, 00:57:38.760 --> 00:57:40.760 basically a long -term intervention with something 00:57:40.760 --> 00:57:43.820 like a psychiatrist or a therapist or a counselor 00:57:43.820 --> 00:57:47.139 that potentially just investigates the stories 00:57:47.139 --> 00:57:49.000 that you're telling yourself and the narrative 00:57:49.000 --> 00:57:53.500 patterns that you tend to fit in. And then you 00:57:53.500 --> 00:57:55.280 basically question those narratives. And then 00:57:55.280 --> 00:57:58.519 you essentially are asking yourself, do I want 00:57:58.519 --> 00:58:00.860 to keep doing this? Because I think a lot of 00:58:00.860 --> 00:58:04.280 people don't think the reason I'm depressed sometimes 00:58:04.280 --> 00:58:06.619 could be neurochemical. But a lot of times it's 00:58:06.619 --> 00:58:09.719 because we repeat behaviors and we're on a cycle. 00:58:09.920 --> 00:58:16.199 It's like if you are a mountain climber and you 00:58:16.199 --> 00:58:18.800 are constantly jumping from mountain to mountain. 00:58:18.900 --> 00:58:23.340 And then you slip and you break your leg. And 00:58:23.340 --> 00:58:25.219 then you go back to mountain climbing the same 00:58:25.219 --> 00:58:29.250 exact way. Of course, the probability of breaking 00:58:29.250 --> 00:58:31.610 your leg is still just as high. But if you do 00:58:31.610 --> 00:58:33.530 it with safety gear or maybe you're like, maybe 00:58:33.530 --> 00:58:36.550 I should be a hiker instead of a mountain climber. 00:58:36.869 --> 00:58:40.329 And then you might still break your leg, but 00:58:40.329 --> 00:58:42.050 the probability of breaking your leg is going 00:58:42.050 --> 00:58:45.489 to be a lot lower. So I say all this is like 00:58:45.489 --> 00:58:48.650 SSRIs and these drugs are amazing, but they're 00:58:48.650 --> 00:58:51.750 not cure -alls. They're really just ways to help 00:58:51.750 --> 00:58:54.010 you see beyond the forest when there's a fog. 00:58:54.559 --> 00:58:56.639 But if you really want to have profound behavioral 00:58:56.639 --> 00:59:00.079 change, things like cognitive behavioral therapy 00:59:00.079 --> 00:59:02.900 and even things like exercise or social engagement 00:59:02.900 --> 00:59:05.280 with other human beings are really good ways 00:59:05.280 --> 00:59:08.500 to reset your neurochemistry so that you can 00:59:08.500 --> 00:59:11.269 have a quote unquote. um, better adapted way 00:59:11.269 --> 00:59:14.429 of living in this life. So just, uh, well, and 00:59:14.429 --> 00:59:16.590 we're going to move into that. One other thing 00:59:16.590 --> 00:59:18.429 that I wanted to, that those are great points, 00:59:18.530 --> 00:59:20.789 Josh. Um, and what we're going to talk about 00:59:20.789 --> 00:59:22.610 that a little bit more in just, just a second. 00:59:22.630 --> 00:59:25.369 I just need one other thing to say. Um, sometimes 00:59:25.369 --> 00:59:28.690 patients with depression can have suicidal thoughts. 00:59:28.789 --> 00:59:31.070 And if that is the case, instead of just sitting 00:59:31.070 --> 00:59:33.150 in that by yourself, you need to call a friend 00:59:33.150 --> 00:59:36.190 or your healthcare provider, or there are suicide 00:59:36.190 --> 00:59:38.869 hotlines. And there is somebody on the other 00:59:38.869 --> 00:59:40.869 end. of that phone that really wants to talk 00:59:40.869 --> 00:59:44.610 to you. So you don't want to do that alone. You 00:59:44.610 --> 00:59:47.110 want to remember that although you feel like 00:59:47.110 --> 00:59:49.369 that nobody cares about you, that's usually, 00:59:49.710 --> 00:59:54.070 that's almost never the case and stuff. So you 00:59:54.070 --> 00:59:57.389 want to make sure that you reach out even, you 00:59:57.389 --> 01:00:00.469 know, and hopefully you've got a friend system 01:00:00.469 --> 01:00:03.269 or a family system around you that they are aware 01:00:03.269 --> 01:00:05.309 that something really drastically is changing 01:00:05.309 --> 01:00:06.590 you and they're going to reach out to you as 01:00:06.590 --> 01:00:11.789 well. That's really well said. Okay. So Josh 01:00:11.789 --> 01:00:15.349 was just talking about cognitive behavioral therapy. 01:00:17.289 --> 01:00:20.590 One of the targets for treating depression is 01:00:20.590 --> 01:00:22.949 what we call remission. So that means that you've 01:00:22.949 --> 01:00:25.409 got a 70 % improvement in symptoms. That's how 01:00:25.409 --> 01:00:30.269 remission is defined. And so not only have medications 01:00:30.269 --> 01:00:33.809 been shown to be utilized and effective in treating 01:00:33.809 --> 01:00:38.230 depression, but also psychotherapy has been shown 01:00:38.230 --> 01:00:40.630 to be effective as well too. And there are different 01:00:40.630 --> 01:00:43.980 types of... of psychotherapy josh just talked 01:00:43.980 --> 01:00:46.420 about cognitive behavioral therapy i thought 01:00:46.420 --> 01:00:48.300 one of the one of the ways that it was defined 01:00:48.300 --> 01:00:51.500 is that you've got what they call cognitive distortions 01:00:51.500 --> 01:00:53.900 and so you tell yourself i fail at everything 01:00:53.900 --> 01:00:57.519 and so they're going to help a therapist a psychiatrist 01:00:57.519 --> 01:01:00.230 that's going to help you really investigate that 01:01:00.230 --> 01:01:02.349 statement and see is there really truth to that 01:01:02.349 --> 01:01:04.610 or not and help you get a right perspective on 01:01:04.610 --> 01:01:06.690 how you're thinking about your own personal life. 01:01:07.429 --> 01:01:10.650 Another therapy that's used is called interpersonal 01:01:10.650 --> 01:01:14.670 therapy. And in this particular therapy, a therapist, 01:01:14.929 --> 01:01:17.489 a counselor, a psychiatrist will focus on one 01:01:17.489 --> 01:01:21.150 or more of several interpersonal situations that 01:01:21.150 --> 01:01:24.289 may relate to initiating or sustaining depression, 01:01:24.710 --> 01:01:27.570 such as if you've got a significant interpersonal 01:01:27.570 --> 01:01:30.590 conflict. or there's a role transition, or there's 01:01:30.590 --> 01:01:32.710 grief, or you've got a social skills deficit, 01:01:32.909 --> 01:01:35.929 they'll talk about that and help you. And they'll 01:01:35.929 --> 01:01:38.050 also include awareness training in that as well, 01:01:38.070 --> 01:01:41.889 too. There's also psychodynamic therapy. This 01:01:41.889 --> 01:01:44.650 is focusing on interpersonal relationships and 01:01:44.650 --> 01:01:47.909 unconscious feelings, desires, and strivings, 01:01:47.909 --> 01:01:51.449 and thoughts, and that they help to treat these 01:01:51.449 --> 01:01:53.969 symptom disorders and stuff. And then there's 01:01:53.969 --> 01:01:55.610 family therapy as well, too, if you've got issues 01:01:55.610 --> 01:01:59.030 going on with family. In refractory cases of 01:01:59.030 --> 01:02:01.289 depression, you've heard of things like electroconvulsive 01:02:01.289 --> 01:02:03.269 therapy, where you actually do get shocked. And 01:02:03.269 --> 01:02:05.010 I don't have all the ins and outs of that, but 01:02:05.010 --> 01:02:07.849 that has that again, that is not. That is not 01:02:07.849 --> 01:02:09.969 the first thing we go to. That is the last thing 01:02:09.969 --> 01:02:12.590 we go to. There's also something that's newer. 01:02:12.690 --> 01:02:15.769 It's called transcranial magnetic stimulation. 01:02:16.570 --> 01:02:18.769 This is kind of fascinating. It's non -invasive, 01:02:18.809 --> 01:02:21.989 but you use magnetic pulses that will help target 01:02:21.989 --> 01:02:24.909 specific areas of your brain to help you get 01:02:24.909 --> 01:02:27.730 better. And then there's a newer medication that's 01:02:27.730 --> 01:02:30.880 used. derivative of ketamine, which is used actually 01:02:30.880 --> 01:02:33.840 as an anesthetic and it's used for pain. But 01:02:33.840 --> 01:02:37.559 there's a newer one called esketamine or Spravato. 01:02:37.780 --> 01:02:40.699 And it has actually been used to help patients 01:02:40.699 --> 01:02:42.860 that are refractory in their treatment for depression. 01:02:43.380 --> 01:02:46.360 And they're not sure exactly of the mechanism, 01:02:46.539 --> 01:02:49.980 but it may involve another receptor called NMDA 01:02:49.980 --> 01:02:54.619 in our synapses and stuff. So one of the questions 01:02:54.619 --> 01:02:57.139 that Josh asked me when we prepared for this 01:02:57.139 --> 01:03:04.699 was, how do antidepressants compare to psychotherapy? 01:03:05.519 --> 01:03:07.780 Remember, one of the things too that we want 01:03:07.780 --> 01:03:12.409 to remember is that In a plan for treating depression, 01:03:12.809 --> 01:03:15.809 it needs to be a collaborative plan. So what 01:03:15.809 --> 01:03:18.030 that means is that the patient needs to be involved 01:03:18.030 --> 01:03:20.550 in choosing how they're going to get managed 01:03:20.550 --> 01:03:23.449 in addition to the healthcare providers and maybe 01:03:23.449 --> 01:03:26.030 family members as well too. Because if the patient 01:03:26.030 --> 01:03:29.190 is not buying into this, then they may not do 01:03:29.190 --> 01:03:40.809 it. So there is evidence that shows that In mild 01:03:40.809 --> 01:03:43.929 to moderate major depressive disorder, actually 01:03:43.929 --> 01:03:48.929 psychotherapy is recommended by guidelines over 01:03:48.929 --> 01:04:00.610 pharmacotherapy or medications. With medications, 01:04:00.809 --> 01:04:03.909 you potentially have adverse effects. And so 01:04:03.909 --> 01:04:06.550 if you have psychotherapy, you don't really have... 01:04:07.039 --> 01:04:09.760 adverse effects per se, except for having to 01:04:09.760 --> 01:04:12.139 face a particular situation that can also, you 01:04:12.139 --> 01:04:13.880 might consider an adverse effect as well too, 01:04:13.940 --> 01:04:16.460 but it's not induced by a medication per se. 01:04:16.780 --> 01:04:19.480 Yeah, the adverse effect is crying in front of 01:04:19.480 --> 01:04:21.320 your therapist. Yeah, there you go. But you know 01:04:21.320 --> 01:04:25.880 what? That's healthy. It is. If by chance psychotherapy 01:04:25.880 --> 01:04:32.440 is not something that you can afford or commit 01:04:32.440 --> 01:04:35.659 to, medications can also be used in mild to moderate 01:04:35.659 --> 01:04:38.400 depression. When you get to the moderate and 01:04:38.400 --> 01:04:43.800 severe cases of major depressive disorder, antidepressant 01:04:43.800 --> 01:04:45.820 medications are recommended and they're often 01:04:45.820 --> 01:04:49.400 recommended alongside or in concert with psychotherapy. 01:04:49.500 --> 01:04:54.780 So trials and research has shown that these treatments 01:04:54.780 --> 01:04:58.440 are additive so that you get antidepressants. 01:04:58.440 --> 01:05:01.059 So Josh talks about that fog lifting, but then 01:05:01.059 --> 01:05:06.210 you've got a psychotherapy. mechanism that you're 01:05:06.210 --> 01:05:09.190 using that helps deal with those things that 01:05:09.190 --> 01:05:13.550 you're having to face and may help you face them 01:05:13.550 --> 01:05:20.849 in a healthier way. So there are some limits 01:05:20.849 --> 01:05:23.630 to psychotherapy. Cost is going to be one of 01:05:23.630 --> 01:05:26.449 them because they're usually not covered by your 01:05:26.449 --> 01:05:28.329 insurance plans. There might be some insurance 01:05:28.329 --> 01:05:30.869 plans. If you've got a more robust insurance 01:05:30.869 --> 01:05:33.849 plans, they can be covered by them. But not all 01:05:33.849 --> 01:05:37.010 people are going to have that luxury. So it could 01:05:37.010 --> 01:05:38.789 be something that you need to just have to figure 01:05:38.789 --> 01:05:40.170 out whether or not you can include it in your 01:05:40.170 --> 01:05:42.610 budget. Yeah, it's one of those interesting things 01:05:42.610 --> 01:05:45.710 where therapy is more qualitative than quantitative 01:05:45.710 --> 01:05:48.789 because it's like. when you're feeling better, 01:05:48.969 --> 01:05:52.110 like they try to correlate it to a scale, you 01:05:52.110 --> 01:05:54.369 know, like mom said, like you have 70%, you know, 01:05:54.369 --> 01:05:56.789 of your symptoms reduced, but someone has to 01:05:56.789 --> 01:05:58.610 give you basically a questionnaire. Like, do 01:05:58.610 --> 01:06:00.110 you feel like this? Do you feel like that? And 01:06:00.110 --> 01:06:02.269 I can even tell you like week to week, sometimes 01:06:02.269 --> 01:06:04.570 that questionnaire will be different depending 01:06:04.570 --> 01:06:08.590 on my day. Um, so a therapist, like one of the 01:06:08.590 --> 01:06:10.909 best indications that your therapy is actually 01:06:10.909 --> 01:06:12.889 working, it's actually the only indication that 01:06:12.889 --> 01:06:15.920 therapy is effective is do you feel. that your 01:06:15.920 --> 01:06:18.659 therapist has your interest at heart. That is 01:06:18.659 --> 01:06:21.980 the only predictive measure of a therapy actually 01:06:21.980 --> 01:06:26.460 working, which is kind of crazy to me. So this 01:06:26.460 --> 01:06:29.360 idea of like, that's gotta be very troubling 01:06:29.360 --> 01:06:31.800 for insurance companies. I think a lot of people 01:06:31.800 --> 01:06:34.840 like to rat on insurance companies and pharmaceutical 01:06:34.840 --> 01:06:37.420 companies because they do wanna make a lot of 01:06:37.420 --> 01:06:39.820 money, which is fair, they do. And there's a 01:06:39.820 --> 01:06:41.659 lot of perverse incentives there. But at the 01:06:41.659 --> 01:06:44.179 end of the day, it is so much easier to codify. 01:06:46.170 --> 01:06:49.590 and associated with clinical trials than something 01:06:49.590 --> 01:06:51.630 like therapy. And I'm hoping that we'll catch 01:06:51.630 --> 01:06:54.309 up to this. We'll have more clinical trials associated 01:06:54.309 --> 01:06:56.309 with cognitive behavioral therapy and these other 01:06:56.309 --> 01:07:00.510 therapeutic modalities because it's changed my 01:07:00.510 --> 01:07:05.230 life. But there's never like you get 10 therapy 01:07:05.230 --> 01:07:08.670 sessions and then you see this reduction. It's 01:07:08.670 --> 01:07:11.449 very random. It's very patient -specific. It's 01:07:11.449 --> 01:07:13.150 very patient -specific and you never know when 01:07:13.150 --> 01:07:15.579 your breakthrough is going to be. And so it really 01:07:15.579 --> 01:07:18.619 does behoove you to kind of keep going and pulling 01:07:18.619 --> 01:07:20.940 on a thread. But like mom said, that can be very 01:07:20.940 --> 01:07:23.179 expensive. You know, sometimes therapy can be 01:07:23.179 --> 01:07:26.880 160 to $300 a session. And if you don't have 01:07:26.880 --> 01:07:29.440 that type of money, then it might be better to 01:07:29.440 --> 01:07:34.019 stick with the medication. And I think too, that 01:07:34.019 --> 01:07:37.519 I think a therapist and you as a patient need 01:07:37.519 --> 01:07:44.820 to recognize when you're done. Because you don't 01:07:44.820 --> 01:07:47.719 want to become dependent on the therapist to 01:07:47.719 --> 01:07:52.139 help you do life. They should be professional 01:07:52.139 --> 01:07:56.119 enough to know when to set you free, per se. 01:07:56.280 --> 01:07:58.340 It's kind of like a parent. Yes, it is. Absolutely. 01:07:58.559 --> 01:08:00.880 So, so you don't want to have this like, Oh, 01:08:00.900 --> 01:08:02.559 I've got to, I've got, I've got to go see my 01:08:02.559 --> 01:08:04.420 therapist because I can't do life without them. 01:08:04.460 --> 01:08:06.000 That's not going to be healthy. Now, initially 01:08:06.000 --> 01:08:08.880 you may feel like that, but, um, but then there's 01:08:08.880 --> 01:08:10.400 going to be a time when they're going to have, 01:08:10.440 --> 01:08:12.880 hopefully a good therapist is going to give you 01:08:12.880 --> 01:08:16.180 the skills that you need when you're alone on 01:08:16.180 --> 01:08:18.720 a Saturday night, you can still cope and do life. 01:08:18.880 --> 01:08:21.640 Yeah. That's really well said. Yeah. You can 01:08:21.640 --> 01:08:23.960 get addicted to a therapist. Like you get addicted 01:08:23.960 --> 01:08:27.090 to a drug. Yes. Yeah. Yes, you can. whole goal 01:08:27.090 --> 01:08:29.829 is to do it on your own right that's scary but 01:08:29.829 --> 01:08:32.899 you got to do it on your own Another limitation 01:08:32.899 --> 01:08:35.500 of psychotherapy is like the logistics. If you're 01:08:35.500 --> 01:08:38.420 working, unlike Josh who gets to pick his hours 01:08:38.420 --> 01:08:41.159 and when he decides to work, other people had 01:08:41.159 --> 01:08:43.439 to work, you know, according to a time frame. 01:08:43.920 --> 01:08:46.399 And maybe you can't get off, maybe you can't 01:08:46.399 --> 01:08:48.420 go to your appointments because it's too far 01:08:48.420 --> 01:08:51.560 away or you don't have freedom in your work schedule 01:08:51.560 --> 01:08:54.439 to do that. Or maybe you live in a more rural 01:08:54.439 --> 01:08:57.979 area and you don't have quality therapists in 01:08:57.979 --> 01:09:00.020 your area. That could also be an issue as well 01:09:00.020 --> 01:09:03.520 too. it could be that you're a lot more reluctant 01:09:03.520 --> 01:09:05.760 to go talk to somebody than just take a medication. 01:09:06.479 --> 01:09:11.460 So those can sometimes be limitations to promote 01:09:11.460 --> 01:09:15.020 or pursue psychotherapy. But they are really 01:09:15.020 --> 01:09:18.420 effective therapies, especially if you don't 01:09:18.420 --> 01:09:20.720 have really severe depression. And for sure, 01:09:20.720 --> 01:09:23.020 in severe depression with medication along with 01:09:23.020 --> 01:09:26.180 it, there's evidence that you do get better. 01:09:27.500 --> 01:09:30.119 We have a few kind of, we always end, we always 01:09:30.119 --> 01:09:32.819 kind of wrap up or go to the end of our podcast 01:09:32.819 --> 01:09:34.979 each week with looking at what we call myths 01:09:34.979 --> 01:09:37.399 or maybe a little bit of untruths associated 01:09:37.399 --> 01:09:41.659 with misconceptions. So we've got our list for 01:09:41.659 --> 01:09:45.819 our antidepressants this week as well. So our 01:09:45.819 --> 01:09:48.420 first, since we're talking primarily about SSRIs, 01:09:48.420 --> 01:09:51.750 the first myth is that antidepressants like SSRIs 01:09:51.750 --> 01:09:54.590 just increase serotonin levels. And that really 01:09:54.590 --> 01:09:58.029 is partially true. They do that, but there are 01:09:58.029 --> 01:10:01.430 other antidepressants that can also affect other 01:10:01.430 --> 01:10:04.170 neurotransmitter systems and that you also may 01:10:04.170 --> 01:10:08.590 desensitize serotonergic receptors. So there's 01:10:08.590 --> 01:10:10.909 a lot of all kinds of things that are going on 01:10:10.909 --> 01:10:13.760 in managing depression other than just... making 01:10:13.760 --> 01:10:15.659 sure that your serotonin levels are increased. 01:10:15.779 --> 01:10:20.500 So you want to make sure that your mind is broadened 01:10:20.500 --> 01:10:24.399 as far as how they work. This was an interesting 01:10:24.399 --> 01:10:28.359 one. Antidepressants like SSRIs can change a 01:10:28.359 --> 01:10:32.640 patient's personality. And if you've been living 01:10:32.640 --> 01:10:37.859 in a state for a while and you start taking an 01:10:37.859 --> 01:10:41.260 antidepressant, you may recognize that you are 01:10:41.260 --> 01:10:44.789 doing life differently, that you do respond to 01:10:44.789 --> 01:10:47.510 things differently. Because the antidepressant, 01:10:47.510 --> 01:10:50.369 like an SSRI, is helping to relieve those depression 01:10:50.369 --> 01:10:53.670 symptoms so that you maybe don't feel sad or 01:10:53.670 --> 01:10:57.210 hopeless all the time anymore. But they're not 01:10:57.210 --> 01:11:01.630 designed to change who a person is. But a potential 01:11:01.630 --> 01:11:03.850 antidepressant adverse effect is what we call 01:11:03.850 --> 01:11:06.880 emotional blunting. And what I mean by that is 01:11:06.880 --> 01:11:09.779 that you could feel less intense emotions. You 01:11:09.779 --> 01:11:13.279 feel maybe a little flatter because while it 01:11:13.279 --> 01:11:16.300 dealt with the emotional pain and helps to make 01:11:16.300 --> 01:11:19.819 that not be so dramatic in your life, it also 01:11:19.819 --> 01:11:23.140 may also take away some of your enjoyment. And 01:11:23.140 --> 01:11:27.020 so it appears to occur in about anywhere from 01:11:27.020 --> 01:11:31.939 4 % to 60 % of patients that take an SSRI. And 01:11:31.939 --> 01:11:37.279 so... you, in order to deal with that, um, and 01:11:37.279 --> 01:11:39.039 it could be due to interference with reinforcement 01:11:39.039 --> 01:11:45.039 learning or, um, and, and so, um, yeah, as far 01:11:45.039 --> 01:11:49.159 as what, what I mean by that is that, um, it, 01:11:49.239 --> 01:11:53.319 if we, if, you know, it's like, if I love chocolate 01:11:53.319 --> 01:11:58.060 and, um, I, I, and I love Diet Coke. Um, and, 01:11:58.100 --> 01:12:01.600 but if the the sensations that i get from eating 01:12:01.600 --> 01:12:05.819 chocolate or diet coke are are reduced i might 01:12:05.819 --> 01:12:07.680 not want to do that as much and so that's what 01:12:07.680 --> 01:12:11.159 i mean as far as um reinforcement so the more 01:12:11.159 --> 01:12:13.039 i drink diet coke the more i drink it you know 01:12:13.039 --> 01:12:14.640 or the more i eat chocolate the more i want it 01:12:14.640 --> 01:12:16.460 but it's like if this is flattened a little bit 01:12:16.460 --> 01:12:18.199 then you don't do that so you don't want to do 01:12:18.199 --> 01:12:20.600 those things as much so yeah it's a question 01:12:20.600 --> 01:12:22.420 you really have to ask yourself because i'll 01:12:22.420 --> 01:12:26.119 have friends who will tell me I really appreciate 01:12:26.119 --> 01:12:30.260 your joy of life. I am a person, as my mom knows, 01:12:30.319 --> 01:12:32.420 has very high highs, but I can also have very 01:12:32.420 --> 01:12:35.920 low lows. I feel things very intensely. And it 01:12:35.920 --> 01:12:39.920 has a cost. And some people might want to not 01:12:39.920 --> 01:12:41.819 feel that way anymore. They might want to feel 01:12:41.819 --> 01:12:44.319 more level. And maybe chocolate doesn't taste 01:12:44.319 --> 01:12:46.970 as good, but hey, at least I don't get... extremely 01:12:46.970 --> 01:12:51.590 existential sadness. Um, so it's, it's just one 01:12:51.590 --> 01:12:52.869 of those things that you just going to have to 01:12:52.869 --> 01:12:55.029 ask, like personality is a really interesting 01:12:55.029 --> 01:12:57.550 topic. You know, it's like, yeah, what makes 01:12:57.550 --> 01:13:01.109 you, you, and, uh, can you mute some of those 01:13:01.109 --> 01:13:03.050 parts of yourself to enhance part of the others? 01:13:03.210 --> 01:13:05.930 And, um, there's a lot of ways to do that. Um, 01:13:05.989 --> 01:13:08.229 and not just drug wise, even exercise or music 01:13:08.229 --> 01:13:10.789 you listen to, or going for a walk, or it's like, 01:13:10.829 --> 01:13:13.630 we all do things that I'm sure we've all had 01:13:13.630 --> 01:13:15.029 this experience where we hang out with different 01:13:15.029 --> 01:13:17.189 people. And they bring out different sides of 01:13:17.189 --> 01:13:19.909 us. And it doesn't mean that our personalities 01:13:19.909 --> 01:13:21.850 change. It just means that different parts of 01:13:21.850 --> 01:13:24.270 us are enhanced at that particular moment. As 01:13:24.270 --> 01:13:26.569 far as this emotional blunting is concerned, 01:13:26.810 --> 01:13:30.109 there are things that can be done. Maybe it's. 01:13:30.319 --> 01:13:32.520 maybe you're taking a higher dose than you actually 01:13:32.520 --> 01:13:35.699 need. So the dose could be reduced. Or a different 01:13:35.699 --> 01:13:39.600 antidepressant class may help, even though, you 01:13:39.600 --> 01:13:41.699 know, I'm not saying, maybe it's a tricyclic 01:13:41.699 --> 01:13:44.859 that you need, you know, instead of an SSRI, 01:13:45.000 --> 01:13:47.779 if this is really causing a lot of issues and 01:13:47.779 --> 01:13:49.760 stuff. So you just have to play around with it 01:13:49.760 --> 01:13:54.590 and stuff. Another myth is that antidepressants 01:13:54.590 --> 01:13:57.789 like SSRIs are addictive. Absolutely not. They 01:13:57.789 --> 01:13:59.909 don't produce cravings or compulsive disorders. 01:14:00.270 --> 01:14:04.109 But remember, an SSRI has to be tapered down 01:14:04.109 --> 01:14:06.909 off when it's discontinued and not abruptly stopped, 01:14:07.069 --> 01:14:08.970 or you could have some withdrawal symptoms that 01:14:08.970 --> 01:14:12.409 could look like a withdrawal symptom from taking 01:14:12.409 --> 01:14:18.859 illicit medication. Another myth is that antidepressants, 01:14:18.859 --> 01:14:21.140 we've kind of alluded to this, like SSRIs are 01:14:21.140 --> 01:14:24.220 a quick fix or a rescue medication. And it is 01:14:24.220 --> 01:14:26.859 not a quick fix. Treating a mental health disorder 01:14:26.859 --> 01:14:32.960 is a longer treatment process than treating an 01:14:32.960 --> 01:14:35.739 infection with an antibiotic. And so you need 01:14:35.739 --> 01:14:38.140 to give it time and you need to give permission. 01:14:38.340 --> 01:14:41.100 You need to allow permission to give it time 01:14:41.100 --> 01:14:44.829 to help you feel better. I wonder if a great 01:14:44.829 --> 01:14:47.729 tool for that would just be do like a little 01:14:47.729 --> 01:14:49.989 basic journal of just like, how am I feeling 01:14:49.989 --> 01:14:53.949 today? So that you can look back over time. And 01:14:53.949 --> 01:14:55.630 just because I'm sure it's just hard to like 01:14:55.630 --> 01:14:57.789 be objective with your feelings because by definition, 01:14:57.810 --> 01:14:59.890 they're very subjective. Absolutely. About how 01:14:59.890 --> 01:15:03.390 you feel about the world. I even will feel that 01:15:03.390 --> 01:15:05.109 way if I've journaled and I'll look back and 01:15:05.109 --> 01:15:07.109 be like, oh my gosh, I can't believe I felt that 01:15:07.109 --> 01:15:10.529 way. But I did. And then it's just a really nice 01:15:10.529 --> 01:15:14.710 reminder that you can get through it. And that, 01:15:14.710 --> 01:15:16.810 yeah, that better days hopefully will be able 01:15:16.810 --> 01:15:19.550 to come. Right. And then the last one is that, 01:15:19.630 --> 01:15:23.510 and this can definitely happen. Well, antidepressants, 01:15:23.529 --> 01:15:25.289 I tried them in the past and they don't work. 01:15:25.350 --> 01:15:27.449 So they're not going to work in the future. But 01:15:27.449 --> 01:15:31.670 we have so many different antidepressants. And 01:15:31.670 --> 01:15:34.770 within a class, one might work better for a patient 01:15:34.770 --> 01:15:38.470 than another one. So you cannot. That's a total 01:15:38.470 --> 01:15:41.250 lie. So if something didn't work in the past, 01:15:41.270 --> 01:15:43.350 then there's an option to try something else 01:15:43.350 --> 01:15:46.770 that could work better in the future. So make 01:15:46.770 --> 01:15:51.390 sure that you give it a chance if you're really 01:15:51.390 --> 01:15:55.069 struggling with depression or other mental health 01:15:55.069 --> 01:15:58.090 disorders that, you know, there may be a way 01:15:58.090 --> 01:16:00.010 that you and your health care provider can come 01:16:00.010 --> 01:16:02.170 up with a plan and a medication that could work 01:16:02.170 --> 01:16:05.260 for you. Because it could have been that when 01:16:05.260 --> 01:16:07.439 you took it in the past, the dose was too low. 01:16:07.579 --> 01:16:09.619 Maybe you just needed, this is a situation where 01:16:09.619 --> 01:16:11.960 you needed to bump up the dose rather than bump 01:16:11.960 --> 01:16:14.979 it down. Or maybe you took it too short the last 01:16:14.979 --> 01:16:17.039 time. You didn't give it enough time to work. 01:16:17.600 --> 01:16:21.079 Or maybe you were only taking it as needed. That's 01:16:21.079 --> 01:16:22.920 never going to work. Because if you only take 01:16:22.920 --> 01:16:26.060 it on every, you know, on Mondays of every week, 01:16:26.100 --> 01:16:27.680 it's not going to work. You know, so if you've 01:16:27.680 --> 01:16:29.420 got to take it consistently and stuff, kind of 01:16:29.420 --> 01:16:32.710 like a blood pressure lowering medication. Anyway, 01:16:32.770 --> 01:16:37.510 so to wrap up, I think some of the concluding 01:16:37.510 --> 01:16:41.430 statements I would make about this topic is that 01:16:41.430 --> 01:16:45.010 serotonin's role in the pathophysiology of depression 01:16:45.010 --> 01:16:48.340 and other mental health... has been observed, 01:16:48.619 --> 01:16:51.140 and it's also being refined, trying to understand 01:16:51.140 --> 01:16:54.560 it more clearly. And the reason we refine and 01:16:54.560 --> 01:16:56.899 want to look at it more clearly is so even maybe 01:16:56.899 --> 01:16:59.939 newer medications that are more targeted can 01:16:59.939 --> 01:17:02.500 be designed or that they also have less adverse 01:17:02.500 --> 01:17:12.399 effects. SSRIs have been shown to improve. treatment 01:17:12.399 --> 01:17:15.159 of depression and they've also been shown to 01:17:15.159 --> 01:17:19.079 be effective in concert with psychotherapy psychotherapy 01:17:19.079 --> 01:17:20.800 has also been shown to be used alone but it's 01:17:20.800 --> 01:17:23.880 also been shown to be additive effects with other 01:17:23.880 --> 01:17:26.800 antidepressants to help patients with depressive 01:17:26.800 --> 01:17:29.859 disorders and I believe I didn't look into psychotherapy 01:17:29.859 --> 01:17:32.420 with other mental health disorders but I'm sure 01:17:32.420 --> 01:17:36.659 that you could find effect for them with PTSD, 01:17:36.899 --> 01:17:39.939 post -traumatic stress disorder, or anxiety disorder 01:17:39.939 --> 01:17:44.380 as well. Yeah, like PTSD, SSRIs in particular, 01:17:44.460 --> 01:17:48.779 were not shown to be as effective as maybe psychotherapy. 01:17:49.000 --> 01:17:53.739 But something like OCD, they worked well in concert 01:17:53.739 --> 01:18:00.190 together. Interestingly enough, exercise. With 01:18:00.190 --> 01:18:03.609 anxiety compared to an SSRI was comparable. I 01:18:03.609 --> 01:18:06.270 would agree there. And there was a potential 01:18:06.270 --> 01:18:08.510 bias there because there was a large dropout 01:18:08.510 --> 01:18:11.210 rate in the exercise group, which makes a lot 01:18:11.210 --> 01:18:12.569 of sense. You're forcing people to exercise. 01:18:12.750 --> 01:18:14.970 So maybe the potential, the people who were left 01:18:14.970 --> 01:18:17.210 behind were the people who just really wanted 01:18:17.210 --> 01:18:20.149 to exercise and they got the benefit of it. So 01:18:20.149 --> 01:18:22.109 there's always kind of that selection bias going 01:18:22.109 --> 01:18:24.310 on, but I thought it was really interesting. 01:18:24.550 --> 01:18:28.199 Yeah. That they were comparable. There's a lot 01:18:28.199 --> 01:18:30.760 of different options out there. And again, whether 01:18:30.760 --> 01:18:32.939 you're using drugs or whether you're using behaviors 01:18:32.939 --> 01:18:36.020 or talking to a therapist, you're always altering 01:18:36.020 --> 01:18:37.880 your brain chemistry because you're literally 01:18:37.880 --> 01:18:40.220 doing things differently than you did before. 01:18:40.399 --> 01:18:42.659 Right. And I think that's the key here is if 01:18:42.659 --> 01:18:45.680 you're in a tough spot, the only way to get out 01:18:45.680 --> 01:18:47.729 is to try something different. And it's like 01:18:47.729 --> 01:18:49.529 the most counterintuitive thing in the world 01:18:49.529 --> 01:18:51.989 because there's something so satisfying about 01:18:51.989 --> 01:18:55.289 staying sad. When you're sad, you want to listen 01:18:55.289 --> 01:18:57.810 to sad music. You want to watch sad movies. There's 01:18:57.810 --> 01:19:00.449 something like you almost like want the resonant 01:19:00.449 --> 01:19:02.850 frequency of sadness to linger. You want it to 01:19:02.850 --> 01:19:05.569 echo. But if you – I think it's good to do that 01:19:05.569 --> 01:19:07.649 for a little bit. But then at the end of the 01:19:07.649 --> 01:19:10.189 day, like is this what I want my life to be? 01:19:10.310 --> 01:19:13.369 And most of the time the answer is no. So just, 01:19:13.470 --> 01:19:17.260 yeah, you just got to break out. And if it's 01:19:17.260 --> 01:19:19.319 really severe, I would definitely recommend going 01:19:19.319 --> 01:19:22.880 to a psychiatrist and talking about antidepressants 01:19:22.880 --> 01:19:26.100 and to see if they can help lift that fog of 01:19:26.100 --> 01:19:29.880 war. Yeah. And let me leave our audience with 01:19:29.880 --> 01:19:34.000 this last just reminder that if you have been 01:19:34.000 --> 01:19:38.539 prescribed an SSRI, please do not abruptly discontinue 01:19:38.539 --> 01:19:40.180 it because it can make you feel really sick. 01:19:41.039 --> 01:19:43.479 That's really well said. Well, if you're feeling 01:19:43.479 --> 01:19:45.630 sad, we hope that you've made... We made you 01:19:45.630 --> 01:19:48.170 a little bit happier today. Or gave you some 01:19:48.170 --> 01:19:51.869 tools, you know, to help, you know, maybe go 01:19:51.869 --> 01:19:54.989 in a different direction. Yeah. Yeah. So go for 01:19:54.989 --> 01:19:59.789 a walk, talk to a friend, and just remember that 01:19:59.789 --> 01:20:01.989 you're worth living this life for. There you 01:20:01.989 --> 01:20:05.390 go. And so until next time, my name's Josh. And 01:20:05.390 --> 01:20:09.670 I'm Jenny. And this is another episode of Your 01:20:09.670 --> 01:20:12.149 Mom on Drugs. We'll talk to you next time. Bye. 01:20:16.430 --> 01:20:17.710 Thank you.