This Is Your Brain On Drugs Psychiatry Podcast

We are making our way through the atypical antidepressants and up next are the so called serotonin modulators and stimulators, vilazodone and vortioxetine. To me these are more similar to the SSRIs and like the SSRIs they do a little extra on top of serotonin reuptake inhibition, but for these two medications these effects are touted to be better tolerated than the SSRIs. Is that the case? Find out.

For today's antidepressant category of norepinephrine and dopamine reuptake inhibitor, we just have one medication, bupropion, but it is a very special antidepressant because its adverse effect profile is so much different than all of the other antidepressants we have talked about, and it is this adverse effect profile that makes bupropion often my first choice for patients not only for depression but also anxiety. Listen and find out why!

I hope you enjoyed the overview of the SNRIs from the last episode. Today I continue with the SNRIs and go through each of the five individually and give you my classic what I like and don't like about each one. We will talk about venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), milnacipran (Savella), and levomilnacipran (Fetzima). So if you aren't quite sure what is different about the drugs in the class, give this episode a listen and find out and also get a healthy dose of my opinions!

On this episode I continue with the SSRIs. In the last episode we discussed them as a class, but today I'll go over each individual SSRI and highlight the subtle differences, advantages, and disadvantages to each med. We will discuss fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). I also discuss how the placebo effect has such a strong impact on the effectiveness of these medications and how different providers exert very different boosts in effectiveness of these medications. These are meds that all docs prescribe, and they are pretty straightforward, but I think you'll learn a thing or three on this one. Have a listen!

Most of the serotonin medications are pretty darn safe, but they come with a pretty long list of adverse effects that can make patients really uncomfortable. In the previous few episodes, I went over some of the biggest and most dangerous adverse effects. On this episode I want to go over the rest of them. I'll talk about the adverse effects in general and then each of the ones we haven't gone over yet, and I'll also talk about what to do about them if they happen. How to talk to patients about them and how to manage them if they occur. These effects can occur with any of the medications we've discussed thus far and with many of the ones to come. Serotonin is a major target for depression and anxiety, so it's important to understand these in more depth so that we can educate our patients, so let's go!

Ever wonder about that pesky "black box" warning on all those antidepressants? Have you ever considered not prescribing to a patient based on that warning or wonder if maybe you shouldn't? Well, then this episode is for you. I'm going to go through the history of this warning, it's intent, and it's consequences. And I hope that after listening that you will feel comfortable prescribing despite the warning because you know what to do with it.

This is a big one! So I chopped it into two episodes. We're talking about sexual adverse effects associated with serotonergic medications. This is a huge adverse effect and it's the one that probably bothers the most patients, but it can be uncomfortable to talk about, so let's talk about it. What can we do about this adverse effect while still getting the positive effect from the medication. Let's start by going over why it happens and some techniques to stop it if it does. Then in Part 2 I'll go into depth on the PDE5 inhibitors like Viagra.

Let's get to know the second generation antidepressants, otherwise known as receptor selective antidepressants. These antidepressants started in the 1980s with the newest one coming out just last year. They tend to only mingle with one or two receptors and have much lower adverse effects than the MAOis and TCAs. They are what most of us think about when we think about antidepressants. In this episode we do an overview of them from FDA approved uses to off label uses. And at the end a little bonus content. I talk about contraindications of the TCAs which I missed in the last episode.

Now that we better understand the neuroreceptors in our brains, let's tackle the tricyclic antidepressants. These used to be a mainstay of psychiatric medication treatment for depression. Not so anymore as we have safer medications that have WAY less adverse effects, but they're still used; not as much for depression but for their other effects like with chronic pain, poor sleep, and more. I'd wager primary care uses them more than psychiatrists. They can help but they sure can hurt as well. Let's find out more about them!

It's episode 6 and we're talking about the first antidepressants, the MAOI's! How do this things work? Aren't they really dangerous and not used anymore? No and No!! You too can use these medications to treat depression. Listen and find out how!

Today I'll start talking about treatments for depression. I'll go over lifestyle modification recommendations, psychotherapy, complementary treatments, and somatic treatments. I'll cover the last two in more detail later in the depression series, and I'll start the next episode with an overview of antidepressants.

Let's get started learning some basics about depression before we dive into medication treatments. From what exactly is it to where do we think it comes from, even if you are a seasoned veteran I'm betting you will learn something from this introduction to the most frequently prescribed psychiatric medications.