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Speaker 1: Jim Keeney is with US doctor Jim, chief medical officers

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Speaker 1: for Dignity Saint Mary Medical Center in Long Beach.

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Speaker 2: Good morning, Jim, Good morning Mill.

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Speaker 1: Okay, do we want to do the antidepressant story first,

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Speaker 1: because I know you think that's pretty important, or the

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Speaker 1: new flu virus. I'm going to throw it to you.

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Speaker 1: What do you think?

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Speaker 2: Let's let's do the flu virus first and then we

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Speaker 2: can talk a little bit longer about the antidepressant one.

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Speaker 1: Okay, the flu virus. I take one. Every year, I

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Speaker 1: get one. And what am I looking at this year?

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Speaker 2: Yeah? So this year the interesting information out is that

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Speaker 2: there is an emerging strain that they're seeing more commonly

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Speaker 2: in places like the UK, Japan, and Canada that are

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Speaker 2: already starting to see it. It's called subclade K and

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Speaker 2: it's one of the you know, we have all those

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Speaker 2: H and N variants for influenza influenza A, and this

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Speaker 2: is the H three N two that's the one that

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Speaker 2: has what we call antigenic drift. It means that the

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Speaker 2: antigens that that's what your antibodies attack, can drift a

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Speaker 2: little bit and change so that they evade the immune system.

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Speaker 2: That's why they are frequent causes of outbreaks, and that's

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Speaker 2: why the flu is so successful as an organism, you know,

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Speaker 2: to reproduce and be able to evade all of our defenses.

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Speaker 2: And in this case it's it wasn't in this flu shot,

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Speaker 2: this particular strain was not known. It wasn't it wasn't included,

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Speaker 2: but it still shows that the current in the UK,

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Speaker 2: they're shown that the current flu data is about seventy

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Speaker 2: five percent effective with that influenza vaccine for children and

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Speaker 2: about thirty to forty percent effective against this particular strain

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Speaker 2: for adults. It's still that's not bad protection, not horrible.

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Speaker 2: And the kids are the little They're like little concentrated

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Speaker 2: vectors that are putting this stuff out. They have higher

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Speaker 2: viral loads, they excrete more virus, and they do it

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Speaker 2: for longer than adults do. So really, children are the

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Speaker 2: little careers for this thing that get us all sick.

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Speaker 1: Now every year we talk about this and effectively what

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Speaker 1: medicine does. These flu baby factory vaccine manufacturers they kind

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Speaker 1: of guess which variant is coming down the pike, and

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Speaker 1: in anticipation of that, they create the vaccine. Do I

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Speaker 1: have that right?

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Speaker 2: Yeah, Yeah, so okay, they look in the southern hemisphere

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Speaker 2: because it's winter, you know, for us in the summer.

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Speaker 1: So it's something they if they guess right, then obviously

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Speaker 1: seventy eighty percent and it's a win. What if the

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Speaker 1: guess is just wrong, is a flu vaccine just not

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Speaker 1: helpful at all? Or you get some protection no matter what.

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Speaker 2: Yeah, so if they guess wrong, you do get less protection.

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Speaker 2: We get a bigger outbreak that you could are you

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Speaker 2: then in a bigger outbreak, maybe you know, that little

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Speaker 2: bit of protection is more important for you, especially if

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Speaker 2: you're one of the high risk groups like elderly, you know,

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Speaker 2: people with lung to these like emphysema, asthma, those type

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Speaker 2: of things, or young children. So you know, you do

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Speaker 2: get some benefit from it. It does reduce your chances

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Speaker 2: of being hospitalized or being you know, or dying from

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Speaker 2: it as well. And you know, you know, tens of

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Speaker 2: thousands of people die every year from this and are hospitalized.

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Speaker 2: And last year was a big year. It was a

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Speaker 2: record year for a people hospitalized for the flu. And

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Speaker 2: that was with a flu that was not something new.

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Speaker 2: It was the standard what we had seen in the past,

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Speaker 2: and the vaccine. It didn't seem quite as effective as

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Speaker 2: we hoped it would be because it was it really

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Speaker 2: wasn't a new variant at that point, So that this

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Speaker 2: year is going to be a tough year and they're

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Speaker 2: going to be looking at things like wastewater surveillance. COVID

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Speaker 2: gave us that, So now we're doing a lot better

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Speaker 2: job of surveillance and knowing we can now know that

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Speaker 2: that signal will elevate. You know, a week or two

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Speaker 2: before that everybody starts showing flu symptoms, so we'll have

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Speaker 2: some early warning. Now.

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Speaker 1: And you're thirty years in the er, I'm assuming you've

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Speaker 1: seen more than your share of people dying of the flu.

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Speaker 1: Do I have that right?

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Speaker 2: Yeah? But you know, thirty years ago people stayed home

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Speaker 2: and died. You know, it's just so now they go

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Speaker 2: to the er and die.

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Speaker 1: Hey, I have a question. You ever look at someone

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Speaker 1: who's just died on you and you say something like, hey,

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Speaker 1: better you than me?

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Speaker 2: Probably not never done that.

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Speaker 1: See, I wish i'd been a doctor, all right, Jim

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Speaker 1: and a depressants and teen sexual development? Yeah, let me

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Speaker 1: ask you questions. You know, aren't teens already pretty sexually developed?

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Speaker 2: Sexually. I mean no, yeah, no, no, no, because we're

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Speaker 2: talking about their brains. We're not talking about Oh.

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Speaker 1: Oh, I'm sorry because I when when I was a teenager,

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Speaker 1: I you know, I would have screwed a tree except

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Speaker 1: for the flint splinters a tree not so anyway, Oh,

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Speaker 1: we don't have to get into that.

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Speaker 2: Let's talk about to tell you please. Yeah. The issue

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Speaker 2: the issue here is that you know this, this hasn't

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Speaker 2: been studied very extensively in teens now. Number one, First,

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Speaker 2: I want to start by saying SSRI, like like prozac

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Speaker 2: and those type of things are life saving and they

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Speaker 2: are extremely safe, unlike a lot of the other medicines

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Speaker 2: we'd use to treat severe depression. That's probably lowered the

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Speaker 2: threshold though for people giving them out because they are

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Speaker 2: so safe. And there's a difference between a teen brain

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Speaker 2: and an adult brain. So when you're depressed as an

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Speaker 2: adult and you they are, they are literally stuck in

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Speaker 2: that depression. What happens is you stop, the neuroplasticity stops,

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Speaker 2: you stop making new synaptic connections and uh, and you

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Speaker 2: just kind of get stuck in a depression. That So

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Speaker 2: these work very well. What we call the neuroplastic you know,

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Speaker 2: the neurotropic hypothesis of depression. This is why when you

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Speaker 2: take prozac, it immediately elevates your serotonin, but it doesn't

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Speaker 2: work for like two to three weeks. That's because it

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Speaker 2: needs to, you know, increase connections. It needs to create

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Speaker 2: new neurons, increase synaptic connections, and it has to create

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Speaker 2: new memories and new processes in your brain. And that

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Speaker 2: works for an adult. But as a team that's already

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Speaker 2: happening to a very high degree. They already are extremely

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Speaker 2: you know, neotropic we call it. Their brain is growing,

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Speaker 2: they're they're pruning back certain connections, they're creating new connections,

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Speaker 2: and it's just going on at a very high level.

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Speaker 2: And now when you throw this monkey wrench in there

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Speaker 2: and you are affecting their their serotonin levels, which then

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Speaker 2: affect all those things. It's through a chemical called brain

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Speaker 2: derived neurotropic factor that's increased in this situation. We don't

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Speaker 2: really know what that does. Now. Again, I'm saying it

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Speaker 2: cautiously though, because so many teens have been helped by the.

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Speaker 1: Same Yes, so let me ask you this. The takeaway

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Speaker 1: for me is that you don't give out these psychotropic drugs.

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Speaker 1: The prose acts very lightly. It takes real depression and

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Speaker 1: where is that line?

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Speaker 2: Yeah, I mean you're you're on the right track exactly.

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Speaker 2: So you don't want to give it out for sadness, right,

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Speaker 2: that's normal human experience. We all get sad. Sometimes there's grieving, right,

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Speaker 2: we don't we agree. When you have a loss, you

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Speaker 2: have grief, and that's a normal human experience. But sometimes

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Speaker 2: grieving turns into a severe depression. And there's a definition

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Speaker 2: for you know, severe depression, and the doctors can identify

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Speaker 2: that and say, look, I mean, especially once people when

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Speaker 2: teens are feeling suicidal or so impulsive that they're at

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Speaker 2: risk for suicidal behavior, that's when this becomes life saving.

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Speaker 2: So it definitely takes a high threshold. And despite how

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Speaker 2: safe these drugs are, there's reason to really believe that

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Speaker 2: they are impacting because when you look at animal models,

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Speaker 2: for sure, they show that adolescent animals who are given

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Speaker 2: this have much less interest in sexual behaviors and that

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Speaker 2: type of thing. And that probably is a reflection of

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Speaker 2: your interest in in bonding and connection in general. So

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Speaker 2: what effect may this be having on the two million

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Speaker 2: teams that are taking the drug in the United States currently.

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Speaker 1: Okay, fair enough, Jim. We'll talk again next Wednesday. Love

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Speaker 1: and the Show with your stuff.

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Speaker 2: Talk to you. Take care,