1 00:00:00,080 --> 00:00:13,320 Speaker 1: Yeah, okay. Welcome to the Therapy for Black Girls Podcast, 2 00:00:13,840 --> 00:00:18,720 Speaker 1: a weekly conversation about mental health, personal development, and all 3 00:00:18,720 --> 00:00:21,400 Speaker 1: the small decisions we can make to become the best 4 00:00:21,400 --> 00:00:25,760 Speaker 1: possible versions of ourselves. I'm your host, Dr joy hard 5 00:00:25,800 --> 00:00:30,560 Speaker 1: and Bradford, a licensed psychologist in Atlanta, Georgia. For more 6 00:00:30,640 --> 00:00:34,640 Speaker 1: information or to find a therapist in your area, visit 7 00:00:34,680 --> 00:00:38,760 Speaker 1: our website at Therapy for Black Girls dot com. While 8 00:00:38,800 --> 00:00:42,479 Speaker 1: I hope you love listening to and learning from the podcast, 9 00:00:42,960 --> 00:00:46,080 Speaker 1: it is not meant to be a substitute for relationship 10 00:00:46,159 --> 00:00:57,040 Speaker 1: with a licensed mental health professional. Hey, y'all, thanks so 11 00:00:57,120 --> 00:00:59,400 Speaker 1: much for joining me for session to Tony one of 12 00:00:59,440 --> 00:01:02,520 Speaker 1: the Therapy for Black Girls Podcast. We'll get right into 13 00:01:02,600 --> 00:01:16,320 Speaker 1: the episode after a word from our sponsors. Last month, 14 00:01:16,520 --> 00:01:20,440 Speaker 1: psychiatrist Dr Karen Glover joined us in our Sister Circle 15 00:01:20,480 --> 00:01:24,720 Speaker 1: community for a conversation all about psychiatric medications, and she 16 00:01:24,800 --> 00:01:27,840 Speaker 1: shared such valuable information that I wanted to share it 17 00:01:27,920 --> 00:01:31,200 Speaker 1: with as many of you as possible. Dr Glover graduated 18 00:01:31,200 --> 00:01:34,680 Speaker 1: from Howard University with a BA in history and then 19 00:01:34,720 --> 00:01:38,400 Speaker 1: worked at Essence Magazine and as an account executive for Verizon. 20 00:01:39,240 --> 00:01:43,560 Speaker 1: She followed her curiosity about medicine and ultimately attended Sunni 21 00:01:43,720 --> 00:01:47,480 Speaker 1: Downstate College of Medicine and obtained a mess of Public 22 00:01:47,520 --> 00:01:52,120 Speaker 1: Health from Columbia University's Mailman School of Public Health via 23 00:01:52,160 --> 00:01:56,600 Speaker 1: the highly competitive Macy Scholars Program. She's currently an assistant 24 00:01:56,640 --> 00:02:00,000 Speaker 1: professor of psychiatry at the Albert Einstein College of Medicine 25 00:02:00,000 --> 00:02:05,160 Speaker 1: and teaches psychopharmacology and aspects of psychotherapy to psychiatry and 26 00:02:05,240 --> 00:02:09,480 Speaker 1: family medicine residents. She's also an attending psychiatrist in the 27 00:02:09,520 --> 00:02:14,040 Speaker 1: Adult Outpatients Psychiatry Department at montefior A Health System. She 28 00:02:14,160 --> 00:02:18,040 Speaker 1: uses mindfulness based techniques in her psychiatry practice, in her 29 00:02:18,080 --> 00:02:22,400 Speaker 1: career coaching for professionals from marginalized cultures, and her leadership 30 00:02:22,480 --> 00:02:25,440 Speaker 1: of discussions of the impact of racism on physical and 31 00:02:25,520 --> 00:02:29,600 Speaker 1: mental health. The conversation you'll hear was between Dr Glover 32 00:02:29,720 --> 00:02:33,600 Speaker 1: and our community manager, Jasmine Jones. They chatted about when 33 00:02:33,639 --> 00:02:37,440 Speaker 1: you might consider talking with a prescriber about medications, some 34 00:02:37,480 --> 00:02:41,680 Speaker 1: common side effects of psychiatric medications, what kinds of information 35 00:02:41,760 --> 00:02:43,960 Speaker 1: you should share with your prescriber to get the best 36 00:02:43,960 --> 00:02:47,960 Speaker 1: medication for you, and general timelines for how long someone 37 00:02:48,040 --> 00:02:50,840 Speaker 1: might take medication. It's important to know that all of 38 00:02:50,880 --> 00:02:54,440 Speaker 1: the information Dr Glover shared was generally speaking and that 39 00:02:54,560 --> 00:02:58,000 Speaker 1: for your specific concerns, you should talk to your healthcare providers. 40 00:02:58,760 --> 00:03:01,160 Speaker 1: If there's something that risen with you or something you 41 00:03:01,160 --> 00:03:04,519 Speaker 1: think others should know. While enjoying the conversation, please don't 42 00:03:04,560 --> 00:03:07,120 Speaker 1: forget to share it on social media using the hashtag 43 00:03:07,600 --> 00:03:13,800 Speaker 1: tbg in session. Here's the conversation. I'm so excited to 44 00:03:13,800 --> 00:03:16,959 Speaker 1: get into this conversation with you, doctor Current. I think 45 00:03:17,000 --> 00:03:19,799 Speaker 1: it's a much needed conversation. I guess we can jump 46 00:03:19,880 --> 00:03:23,440 Speaker 1: right into. A doctor was saying about hesitation and just 47 00:03:23,520 --> 00:03:28,560 Speaker 1: the history of non ethical medical practice in the United States, 48 00:03:28,600 --> 00:03:32,040 Speaker 1: something that is very real and can cause anxiety for 49 00:03:32,120 --> 00:03:35,320 Speaker 1: maybe someone who actually would benefit from medication. So can 50 00:03:35,360 --> 00:03:38,320 Speaker 1: you just speak to how you would help for someone 51 00:03:38,880 --> 00:03:42,600 Speaker 1: to come to terms with being okay with having medication 52 00:03:43,040 --> 00:03:46,760 Speaker 1: and just some comforting facts about the research and work 53 00:03:46,840 --> 00:03:50,680 Speaker 1: that you're personally doing that would benefit black women. Yeah, 54 00:03:50,840 --> 00:03:53,760 Speaker 1: thank you. So a lot of stuff comes out in 55 00:03:53,920 --> 00:03:57,400 Speaker 1: my first and second assessments with the patients. So the 56 00:03:57,440 --> 00:04:00,120 Speaker 1: first time I see somebody, it's usually an hour or 57 00:04:00,160 --> 00:04:04,000 Speaker 1: an hour and a half, and from there we're talking 58 00:04:04,040 --> 00:04:08,120 Speaker 1: about how they've been doing and the impact of their 59 00:04:08,200 --> 00:04:11,720 Speaker 1: depression or their anxiety on their life right now. So 60 00:04:11,960 --> 00:04:14,720 Speaker 1: when we get down to like how this is affecting 61 00:04:14,720 --> 00:04:18,360 Speaker 1: them like and and the consequences if it goes untreated, 62 00:04:18,800 --> 00:04:22,000 Speaker 1: that's kind of where medication comes into the picture. So, 63 00:04:22,120 --> 00:04:24,240 Speaker 1: first of all, I love to make sure that all 64 00:04:24,279 --> 00:04:27,800 Speaker 1: my patients have access to psychotherapy if they want to 65 00:04:27,880 --> 00:04:31,000 Speaker 1: and if they're motivated. And then if somebody is not 66 00:04:31,160 --> 00:04:35,080 Speaker 1: interested in psychotherapy, then I'm like, okay, can we think 67 00:04:35,120 --> 00:04:38,400 Speaker 1: about other ways to take a holistic approach to this? 68 00:04:39,279 --> 00:04:41,640 Speaker 1: And then some people will say, you know, I'm open 69 00:04:41,680 --> 00:04:43,800 Speaker 1: to everything. So then I'll say, all right, look, are 70 00:04:43,800 --> 00:04:47,239 Speaker 1: you interested in exercise? Are you interested in other self 71 00:04:47,279 --> 00:04:51,080 Speaker 1: care practices that have been shown to improve your mood? So? 72 00:04:51,240 --> 00:04:53,279 Speaker 1: Can we make sure you get sunlight? Can we make 73 00:04:53,279 --> 00:04:57,080 Speaker 1: sure you get outside in nature and do some forest bathing, right, 74 00:04:57,120 --> 00:05:00,080 Speaker 1: just getting around some trees. Can I make sure it 75 00:05:00,440 --> 00:05:02,640 Speaker 1: you get to hang around loved ones who affirm who 76 00:05:02,680 --> 00:05:05,200 Speaker 1: you are. And so once we make sure that we're 77 00:05:05,200 --> 00:05:08,159 Speaker 1: taking a holistic approach, and we think through their diet 78 00:05:08,320 --> 00:05:11,040 Speaker 1: and their exercise regimen and whether they've got a good 79 00:05:11,120 --> 00:05:14,480 Speaker 1: diet and lots of green vegetables and mushrooms and things 80 00:05:14,520 --> 00:05:17,800 Speaker 1: like that, right, sardines, all the nutrients. After we make 81 00:05:17,839 --> 00:05:21,080 Speaker 1: sure you've got all the nutrients, all the family love, 82 00:05:22,040 --> 00:05:27,000 Speaker 1: then the question comes, all right, would you consider medication? 83 00:05:27,560 --> 00:05:30,919 Speaker 1: Because sometimes the stakes are really high. So there's some 84 00:05:30,960 --> 00:05:33,320 Speaker 1: people who are at risk of losing their job because 85 00:05:33,400 --> 00:05:36,840 Speaker 1: their depression is so bad that they can't focus. They 86 00:05:36,880 --> 00:05:39,040 Speaker 1: are at risk of losing their job because their social 87 00:05:39,160 --> 00:05:42,760 Speaker 1: anxiety is so intense they won't go on public transportation, 88 00:05:43,279 --> 00:05:45,960 Speaker 1: or they won't show up for work because perhaps work 89 00:05:46,000 --> 00:05:49,479 Speaker 1: requires that you talk and interact with the public. So 90 00:05:50,040 --> 00:05:51,880 Speaker 1: if I know that you're about to lose your job, 91 00:05:51,920 --> 00:05:54,680 Speaker 1: if I know your depression is so bad you're not 92 00:05:54,800 --> 00:05:58,719 Speaker 1: responsive to your growing babies, then we need to think 93 00:05:58,720 --> 00:06:03,960 Speaker 1: about takeing more I think stronger action. And so that's 94 00:06:03,960 --> 00:06:08,760 Speaker 1: where medication also comes in. I openly acknowledge that medicine, 95 00:06:09,480 --> 00:06:13,160 Speaker 1: including psychiatry, has not always been kind to Black people. 96 00:06:13,480 --> 00:06:17,799 Speaker 1: I know that experiments were done, that surgeries were forced 97 00:06:17,839 --> 00:06:21,960 Speaker 1: on us, that there's been coercive tactics to get people 98 00:06:22,000 --> 00:06:26,400 Speaker 1: to take medication and to participate in medication trials that 99 00:06:26,480 --> 00:06:30,080 Speaker 1: we did not give consent to. Right, And so I 100 00:06:30,120 --> 00:06:33,719 Speaker 1: start by acknowledging that for the patient, because often I 101 00:06:33,760 --> 00:06:37,600 Speaker 1: think growing up, we hear about those stories, and yet 102 00:06:37,880 --> 00:06:40,919 Speaker 1: how do we reconcile the history of medicine with who's 103 00:06:40,960 --> 00:06:43,279 Speaker 1: standing in front of me telling me, maybe you want 104 00:06:43,279 --> 00:06:46,720 Speaker 1: to try this lex a pro right or this other medication. 105 00:06:47,560 --> 00:06:50,840 Speaker 1: So I try to just put it all out there 106 00:06:50,880 --> 00:06:53,440 Speaker 1: for the patient and make sure that she knows that 107 00:06:53,520 --> 00:06:56,560 Speaker 1: she can ask me about that, and whatever I don't know, 108 00:06:57,560 --> 00:07:00,440 Speaker 1: we can talk through and I'll look up, I'll research, 109 00:07:00,480 --> 00:07:03,080 Speaker 1: I'll talk to experts, and so from there we just 110 00:07:03,120 --> 00:07:05,840 Speaker 1: try to figure out, like what are the consequences, what's 111 00:07:05,880 --> 00:07:10,160 Speaker 1: the impact, what are our goals, and then what's gonna 112 00:07:10,200 --> 00:07:12,800 Speaker 1: work and sort of like what are the conditions we're 113 00:07:12,800 --> 00:07:15,040 Speaker 1: working under. And so I'm sure we're going to get 114 00:07:15,040 --> 00:07:16,440 Speaker 1: some more of that, but is that's sort of where 115 00:07:16,480 --> 00:07:21,760 Speaker 1: I start. Absolutely, thank you so much for acknowledging that. 116 00:07:21,960 --> 00:07:24,600 Speaker 1: Let's talk about the different classes of drugs that you 117 00:07:24,640 --> 00:07:30,720 Speaker 1: would be prescribing. Psychiatric medication for sure, So I prescribed 118 00:07:30,760 --> 00:07:36,240 Speaker 1: them all, really meaning there's medications that we use, and 119 00:07:36,240 --> 00:07:39,680 Speaker 1: I should say, in medicine, we often find that medications 120 00:07:39,680 --> 00:07:45,400 Speaker 1: are effective inadvertent way, sometimes even by accident, so something 121 00:07:45,480 --> 00:07:48,760 Speaker 1: like lithium. Right, we found out that lithium was good 122 00:07:48,800 --> 00:07:51,720 Speaker 1: for bipolar disorder because we were trying to use it 123 00:07:51,760 --> 00:07:54,520 Speaker 1: for something else, and then we found out it made 124 00:07:55,160 --> 00:07:59,280 Speaker 1: the bipolar folks calmer and better able to function. So 125 00:08:00,000 --> 00:08:02,280 Speaker 1: in the history of medications, we often find that they 126 00:08:02,320 --> 00:08:05,000 Speaker 1: can be used for two things. So there are some 127 00:08:05,120 --> 00:08:11,240 Speaker 1: antibiotics that are oddly good for depression. There are antipsychotics 128 00:08:11,280 --> 00:08:14,840 Speaker 1: that are helpful for psychosis but also for bipolar disorder 129 00:08:15,000 --> 00:08:20,040 Speaker 1: and also to help with depression. So bear in mind 130 00:08:20,080 --> 00:08:25,440 Speaker 1: that even though there are classes of psychotropic medications, we 131 00:08:25,880 --> 00:08:29,040 Speaker 1: sometimes do a little bit of cross pollenation. We may 132 00:08:29,160 --> 00:08:32,760 Speaker 1: use something that has indications for three different things, we 133 00:08:32,800 --> 00:08:35,520 Speaker 1: may use it for something else. So let's bear that 134 00:08:35,559 --> 00:08:39,040 Speaker 1: in mind. So I prescribe medications for psychosis and psychotic 135 00:08:39,080 --> 00:08:44,360 Speaker 1: disorders like schizophrenia. For schizo effective disorder. I prescribe medications 136 00:08:44,400 --> 00:08:48,560 Speaker 1: for anxiety, So that includes medications like xanax, which often 137 00:08:48,600 --> 00:08:52,599 Speaker 1: you hear rappers talk about or housewives right A housewives 138 00:08:52,640 --> 00:08:55,679 Speaker 1: of lots of different places talk about it openly on television. 139 00:08:56,320 --> 00:08:59,960 Speaker 1: I prescribe medications that can be used for seizure disorder, 140 00:09:00,120 --> 00:09:05,040 Speaker 1: but also for bipolar disorder, and of course antidepressants perfect. 141 00:09:05,120 --> 00:09:07,600 Speaker 1: And then are there some drugs that are less effective 142 00:09:07,960 --> 00:09:13,680 Speaker 1: for black women but still being prescribed. I'm gonna say no, ish, 143 00:09:13,960 --> 00:09:19,960 Speaker 1: because I think the field of pharmacogenetics is sort of 144 00:09:20,000 --> 00:09:24,920 Speaker 1: still growing. Typically, the studies that were done to assess 145 00:09:25,000 --> 00:09:30,480 Speaker 1: pharmacogenetics were based on people's the researchers assumptions about who's 146 00:09:30,559 --> 00:09:33,880 Speaker 1: black and who's not. And as you well know, just 147 00:09:33,920 --> 00:09:36,640 Speaker 1: because you look black doesn't mean that is the only 148 00:09:36,720 --> 00:09:40,720 Speaker 1: thing that is genetically making up who you are. So 149 00:09:41,000 --> 00:09:44,920 Speaker 1: some of the what we call alleles that govern how 150 00:09:44,960 --> 00:09:49,240 Speaker 1: a receptor bends or responds in the presence of a drug. 151 00:09:49,640 --> 00:09:53,400 Speaker 1: Sometimes those may come from a white ancestor or an 152 00:09:53,440 --> 00:09:57,439 Speaker 1: Asian ancestor and not the African ancestor. But you still 153 00:09:57,480 --> 00:10:02,200 Speaker 1: may have kinky, coily hair, full lips and look black 154 00:10:02,320 --> 00:10:06,440 Speaker 1: and present as black. And so I have come to 155 00:10:06,600 --> 00:10:11,600 Speaker 1: not really rely on pharmacogenetics or phenotype to figure out 156 00:10:11,640 --> 00:10:16,640 Speaker 1: what works for the patient. There are some rather expensive 157 00:10:16,679 --> 00:10:20,120 Speaker 1: studies that can be run to figure out which antidepressants 158 00:10:20,160 --> 00:10:23,160 Speaker 1: or which medications might be more effective, but that field 159 00:10:23,320 --> 00:10:27,400 Speaker 1: is so new and so expensive, and I work in 160 00:10:27,440 --> 00:10:33,080 Speaker 1: the South bronx where that's just not feasible. So for me, 161 00:10:33,280 --> 00:10:36,040 Speaker 1: the best way to figure out if a medication is 162 00:10:36,080 --> 00:10:40,000 Speaker 1: working is to check in with my patient and say, 163 00:10:40,080 --> 00:10:41,880 Speaker 1: are you able to get out of bed? Did you 164 00:10:41,920 --> 00:10:44,800 Speaker 1: get dressed? Were you able to accomplish the things you 165 00:10:44,800 --> 00:10:50,720 Speaker 1: wanted to accomplish? Yet, unfortunately, sometimes my ability to predict 166 00:10:50,800 --> 00:10:54,160 Speaker 1: or our wish for the medication to work does not 167 00:10:54,320 --> 00:10:56,880 Speaker 1: happen within six or eight weeks, and then we have 168 00:10:57,000 --> 00:11:00,000 Speaker 1: to try something else, and I recognize that that can 169 00:11:00,080 --> 00:11:05,040 Speaker 1: be very, very difficult. So whenever you say six to 170 00:11:05,160 --> 00:11:07,640 Speaker 1: eight weeks, you're saying that is typically the amount of 171 00:11:07,640 --> 00:11:10,640 Speaker 1: time where you would then switch. So you give it 172 00:11:10,720 --> 00:11:13,839 Speaker 1: that much time to feel a difference that you were 173 00:11:13,880 --> 00:11:16,839 Speaker 1: not expecting. Okay, we're two weeks and now how do 174 00:11:16,920 --> 00:11:19,679 Speaker 1: you feel better? Yeah, it depends on the medication. There 175 00:11:19,679 --> 00:11:22,360 Speaker 1: are some medications that work sooner. So if somebody is 176 00:11:22,400 --> 00:11:26,400 Speaker 1: presenting to me with intense anxiety and we try something, 177 00:11:26,720 --> 00:11:31,280 Speaker 1: there's a subset of people, usually twenty percent of people 178 00:11:31,280 --> 00:11:34,120 Speaker 1: who try a medication like an s s r I 179 00:11:34,280 --> 00:11:36,640 Speaker 1: or an s NRI I, who may feel an effect 180 00:11:36,679 --> 00:11:39,720 Speaker 1: within five or so days, and then there's the rest 181 00:11:39,760 --> 00:11:43,040 Speaker 1: of us who may not feel anything for a week 182 00:11:43,160 --> 00:11:46,120 Speaker 1: or two or three. If the person doesn't feel anything 183 00:11:46,160 --> 00:11:48,960 Speaker 1: by four weeks, even if we increase it, even if 184 00:11:48,960 --> 00:11:52,600 Speaker 1: they're tolerating the side effects, then I start to go like, 185 00:11:52,960 --> 00:11:55,680 Speaker 1: I'm not sure, So I may try to optimize the dose, 186 00:11:55,760 --> 00:12:00,400 Speaker 1: meaning get the dose to the towards the maximum, assuming 187 00:12:00,400 --> 00:12:03,079 Speaker 1: they're not having side effects or that the side effects 188 00:12:03,080 --> 00:12:06,679 Speaker 1: are not intolerable. So assuming they can tolerate whatever is happening, 189 00:12:07,040 --> 00:12:10,680 Speaker 1: maybe a little bit of sedation or other side effects 190 00:12:10,679 --> 00:12:12,480 Speaker 1: we can talk about. But if I know that they 191 00:12:12,480 --> 00:12:14,240 Speaker 1: can tolerate it, then I'm going to try to work 192 00:12:14,280 --> 00:12:16,560 Speaker 1: with one medication and try to get it as high 193 00:12:16,640 --> 00:12:19,720 Speaker 1: as possible to treat the symptoms. And that's also where 194 00:12:19,760 --> 00:12:23,840 Speaker 1: psychotherapy comes in, because I think everybody on here knows 195 00:12:23,880 --> 00:12:27,520 Speaker 1: that psychotherapy can be quite impactful for people who are 196 00:12:27,640 --> 00:12:30,920 Speaker 1: motivated and willing to show up for it, and it 197 00:12:31,000 --> 00:12:35,480 Speaker 1: does what antidepressants also do. It sometimes just takes longer 198 00:12:35,520 --> 00:12:38,640 Speaker 1: to see an effect, but sometimes the combination of the 199 00:12:38,720 --> 00:12:43,199 Speaker 1: two can be much more effective and efficient than doing 200 00:12:43,240 --> 00:12:47,239 Speaker 1: one or the other. So a person who is interested 201 00:12:47,480 --> 00:12:51,280 Speaker 1: in getting medication, they don't necessarily have to like go 202 00:12:51,360 --> 00:12:53,679 Speaker 1: through a whole process of speaking with a therapist verse 203 00:12:53,840 --> 00:12:56,960 Speaker 1: or having you know, multiple visits of their psychiatrists. How 204 00:12:56,960 --> 00:12:59,600 Speaker 1: would you go about diagnosing someone and then about how 205 00:12:59,600 --> 00:13:03,080 Speaker 1: long for you diagnosing them until them being actually on 206 00:13:03,160 --> 00:13:06,840 Speaker 1: the medication? Does that typically look like? So it depends 207 00:13:06,880 --> 00:13:10,760 Speaker 1: on the setting. So there's a model of care called 208 00:13:10,800 --> 00:13:16,319 Speaker 1: collaborative care that we do at Montefire where people go 209 00:13:16,480 --> 00:13:18,360 Speaker 1: they don't have First of all, the wait to see 210 00:13:18,360 --> 00:13:20,400 Speaker 1: a psychiatrist is really long, but wait to see any 211 00:13:20,440 --> 00:13:23,440 Speaker 1: kind of prescribers often months long. At the clinic where 212 00:13:23,440 --> 00:13:26,000 Speaker 1: I work, it's unfortunately, like four months to get in 213 00:13:26,000 --> 00:13:29,880 Speaker 1: to see a psychiatrist. So in that case, sometimes people 214 00:13:29,920 --> 00:13:32,280 Speaker 1: go to their primary care doctor. Right because we know 215 00:13:32,320 --> 00:13:35,480 Speaker 1: that primary care doctors do the overwhelming bulk of the 216 00:13:35,559 --> 00:13:40,800 Speaker 1: prescribing of psychotropic medications in the United States, it's not psychiatrists. 217 00:13:40,880 --> 00:13:44,360 Speaker 1: There's only like eight and twenty black psychiatrists and there's 218 00:13:44,400 --> 00:13:48,680 Speaker 1: like eleven thousand psychiatrists in the United States. So we 219 00:13:48,760 --> 00:13:52,240 Speaker 1: know that lots of work is done by primary care doctors. 220 00:13:52,240 --> 00:13:54,679 Speaker 1: So some people go to their primary care doctor. They 221 00:13:54,679 --> 00:13:56,680 Speaker 1: go and get their blood pressure check, they go to 222 00:13:56,720 --> 00:13:59,560 Speaker 1: get their kuma in checked, or whatever. They go to 223 00:13:59,600 --> 00:14:02,280 Speaker 1: their B and they say or their d y N 224 00:14:02,360 --> 00:14:05,160 Speaker 1: doctor and say, like you know, maybe they get assessed 225 00:14:05,240 --> 00:14:08,640 Speaker 1: as part of like triage, and it may come out 226 00:14:08,679 --> 00:14:11,920 Speaker 1: that they have some depressive symptoms. Sometimes the work gets 227 00:14:11,960 --> 00:14:14,440 Speaker 1: done there, especially if there's a social worker there who 228 00:14:14,480 --> 00:14:19,080 Speaker 1: may commence or start off doing psychotherapy or that kind 229 00:14:19,160 --> 00:14:24,200 Speaker 1: of assessment. And then that that social worker may say, hey, 230 00:14:24,320 --> 00:14:26,800 Speaker 1: this person is not benefiting from seeing me. It's been 231 00:14:27,080 --> 00:14:30,800 Speaker 1: for six weeks. Maybe they need to see a psychiatrist, 232 00:14:30,840 --> 00:14:34,200 Speaker 1: and then they'll get referred. So there's that style, which 233 00:14:34,240 --> 00:14:39,080 Speaker 1: is collaborative care. And sometimes that OH B or that 234 00:14:39,240 --> 00:14:41,560 Speaker 1: do I N or that intern ist or that family 235 00:14:41,560 --> 00:14:44,160 Speaker 1: medicine doc will call me and say, hey, Karen, I 236 00:14:44,160 --> 00:14:46,760 Speaker 1: have this patient. Look at their chart. The social worker 237 00:14:46,760 --> 00:14:50,240 Speaker 1: has written this beautiful assessment. I'll look at the assessment 238 00:14:50,280 --> 00:14:52,920 Speaker 1: and I'll say, oh, clearly, this is a twenty eight 239 00:14:52,960 --> 00:14:56,320 Speaker 1: year old woman who wants to get pregnant. She's in 240 00:14:56,360 --> 00:15:02,640 Speaker 1: a relationship, and she is is perhaps struggling with appetite 241 00:15:02,840 --> 00:15:05,080 Speaker 1: and so she's lost a lot of weight. Okay, I 242 00:15:05,120 --> 00:15:07,880 Speaker 1: can think of one medication that could be really helpful 243 00:15:07,920 --> 00:15:10,520 Speaker 1: for her, and I'll tell the O b or I'll 244 00:15:10,520 --> 00:15:14,880 Speaker 1: tell the other like other clinician tried this medication, so 245 00:15:14,960 --> 00:15:18,080 Speaker 1: I will have never seen the patient. But guess what, 246 00:15:18,200 --> 00:15:21,640 Speaker 1: that patient is getting the medication from a prescriber and 247 00:15:21,680 --> 00:15:25,760 Speaker 1: they're being monitored by a therapist in primary care. So 248 00:15:25,800 --> 00:15:29,240 Speaker 1: that's one way to get people access to the medications. 249 00:15:29,760 --> 00:15:33,920 Speaker 1: Then there's seeing me, which again sometimes takes a terribly 250 00:15:34,000 --> 00:15:36,960 Speaker 1: long amount of time and right and as a black 251 00:15:37,000 --> 00:15:40,640 Speaker 1: woman psychiatrist, right, we're we're like unicorns. There's so few 252 00:15:40,640 --> 00:15:43,080 Speaker 1: of us that somebody finally gets to see me, they 253 00:15:43,160 --> 00:15:46,200 Speaker 1: usually means their symptoms are pretty severe. And so in 254 00:15:46,280 --> 00:15:50,360 Speaker 1: that case, have they tried other medications? Do I have 255 00:15:50,440 --> 00:15:54,480 Speaker 1: to like find some new combination between seeing them for 256 00:15:54,480 --> 00:15:56,680 Speaker 1: the first time. It depends on how urgent it is. 257 00:15:56,720 --> 00:15:58,520 Speaker 1: I may start them on something the day that I 258 00:15:58,560 --> 00:16:00,720 Speaker 1: see them and ask them to go pick up a prescription, 259 00:16:01,960 --> 00:16:04,480 Speaker 1: and then after that I'll try to see them weekly 260 00:16:04,560 --> 00:16:06,560 Speaker 1: or every two weeks at least to touch base or 261 00:16:06,600 --> 00:16:09,360 Speaker 1: through tele medicine to find out how they're doing, what 262 00:16:09,360 --> 00:16:12,480 Speaker 1: their symptoms are like. And then sometimes they're feeling better 263 00:16:12,680 --> 00:16:14,920 Speaker 1: within three weeks or you know, by the end of 264 00:16:14,920 --> 00:16:17,720 Speaker 1: the month, we're seeing small changes more from our conversation 265 00:16:17,760 --> 00:16:29,960 Speaker 1: with Dr Glover after the break. One of the questions 266 00:16:29,960 --> 00:16:31,960 Speaker 1: that you had sent me over that you hear a lot, 267 00:16:32,520 --> 00:16:34,680 Speaker 1: and I just thought of while you were talking about that. 268 00:16:34,760 --> 00:16:38,320 Speaker 1: With the trial and error process, is people seeing that, 269 00:16:38,400 --> 00:16:40,400 Speaker 1: how do I know I'm not just being experimented on? 270 00:16:40,960 --> 00:16:44,120 Speaker 1: Can you kind of talk like the process of companies 271 00:16:44,160 --> 00:16:47,320 Speaker 1: doing their own trials and how if you could ever 272 00:16:47,560 --> 00:16:50,520 Speaker 1: end up in that situation and not know it? Yeah, 273 00:16:50,520 --> 00:16:55,400 Speaker 1: that should never happen. Anytime there is a study going on, 274 00:16:55,600 --> 00:16:59,600 Speaker 1: there's a whole consent process that has to be created 275 00:16:59,680 --> 00:17:03,800 Speaker 1: and proved by the institutional review board of whatever institution 276 00:17:03,920 --> 00:17:09,920 Speaker 1: is doing the study. So at any point, if anybody 277 00:17:10,000 --> 00:17:12,760 Speaker 1: is in a study, they know they are in a study. 278 00:17:12,800 --> 00:17:15,280 Speaker 1: They may not know whether they're receiving a placebo or not, 279 00:17:15,400 --> 00:17:18,199 Speaker 1: but that has been discussed ahead of time. There is 280 00:17:18,240 --> 00:17:20,720 Speaker 1: no way you're swallowing a pill that has been given 281 00:17:20,720 --> 00:17:23,720 Speaker 1: to you by me and finding out later that it 282 00:17:23,840 --> 00:17:26,520 Speaker 1: was nothing, or that this is an experiment of you know, 283 00:17:26,920 --> 00:17:32,199 Speaker 1: some evil scientists. The way, unfortunately, that psychiatry gets depicted 284 00:17:32,560 --> 00:17:38,040 Speaker 1: in popular films and television is often that we are corrupt, 285 00:17:38,320 --> 00:17:41,240 Speaker 1: that we are secretly trying to have sex with our 286 00:17:41,280 --> 00:17:44,480 Speaker 1: patients and all kinds of like terrible stereotypes. So it's 287 00:17:44,520 --> 00:17:47,120 Speaker 1: a lot to show up every day and just be like, 288 00:17:47,600 --> 00:17:50,119 Speaker 1: none of that is real. I'm actually a decent person, 289 00:17:50,280 --> 00:17:52,760 Speaker 1: and I really just want to make you feel better. However, 290 00:17:52,920 --> 00:17:56,600 Speaker 1: there are times when I cannot predict which medication will work, 291 00:17:57,160 --> 00:18:00,560 Speaker 1: and I can say, look, I can think of medications 292 00:18:00,600 --> 00:18:03,720 Speaker 1: that can be helpful, that are likely to help you. 293 00:18:04,840 --> 00:18:08,240 Speaker 1: If you can tolerate any potential side effects that come up, 294 00:18:08,480 --> 00:18:11,440 Speaker 1: I will work with you to find something that will 295 00:18:11,480 --> 00:18:13,960 Speaker 1: help you have the life that you want to lead. 296 00:18:15,440 --> 00:18:18,040 Speaker 1: If the medication is not helping you and you don't 297 00:18:18,119 --> 00:18:21,119 Speaker 1: want to take it, please let me know and we 298 00:18:21,200 --> 00:18:25,640 Speaker 1: will find something else. I take no pleasure in other 299 00:18:25,720 --> 00:18:31,560 Speaker 1: people suffering, and I think other psychiatrists are similarly minded. 300 00:18:31,680 --> 00:18:35,760 Speaker 1: Like nobody's out here trying to cause suffering. I love 301 00:18:35,800 --> 00:18:39,640 Speaker 1: to hear that if you've been taking medications for several years, 302 00:18:39,720 --> 00:18:42,520 Speaker 1: will at some point be necessary and have an adjustment 303 00:18:42,880 --> 00:18:46,879 Speaker 1: in the dosage or even just changing medications in general. Yeah, 304 00:18:46,880 --> 00:18:50,480 Speaker 1: so sometimes it is necessary to change medication or to 305 00:18:50,560 --> 00:18:55,120 Speaker 1: change the dose. It depends on pregnancy status, It depends 306 00:18:55,200 --> 00:19:00,800 Speaker 1: on other comorbid conditions, like if you develop blood pressure, 307 00:19:00,800 --> 00:19:03,560 Speaker 1: and we know that there's some medications that at very 308 00:19:03,640 --> 00:19:05,960 Speaker 1: high dose, at the high end of the dose range, 309 00:19:06,000 --> 00:19:10,520 Speaker 1: can be linked to hypertension, will monitor you differently than 310 00:19:10,680 --> 00:19:13,080 Speaker 1: if you were perhaps on a lower dose, or if 311 00:19:13,080 --> 00:19:16,200 Speaker 1: you were in a different age range. So I'd say 312 00:19:16,200 --> 00:19:19,560 Speaker 1: the simplest answer is like, it depends, and it also 313 00:19:19,600 --> 00:19:23,720 Speaker 1: depends on lifestyle changes. So if you know that you 314 00:19:23,760 --> 00:19:28,080 Speaker 1: were previously on a medication that that made you sleepy, 315 00:19:28,160 --> 00:19:30,600 Speaker 1: and but you need to pick up nighttime work for 316 00:19:30,600 --> 00:19:32,679 Speaker 1: whatever reason, right you're a nurse, and you suddenly go 317 00:19:32,800 --> 00:19:35,760 Speaker 1: from working days to nights, then what I want you 318 00:19:35,800 --> 00:19:38,200 Speaker 1: to be on that medication knowing that you're driving home, 319 00:19:38,240 --> 00:19:42,240 Speaker 1: perhaps impaired by sleep deprivation, and about to take this 320 00:19:42,359 --> 00:19:45,320 Speaker 1: medication that might make you a little bit sedated. And 321 00:19:45,359 --> 00:19:47,199 Speaker 1: you've got to also be there for your kids if 322 00:19:47,240 --> 00:19:50,400 Speaker 1: you're a single parent. Things like that I take into account. 323 00:19:50,800 --> 00:19:53,600 Speaker 1: So that's one thing. And then I have had some 324 00:19:53,640 --> 00:19:56,760 Speaker 1: patients who were on one medication for quite a long 325 00:19:56,840 --> 00:19:59,000 Speaker 1: time and then they felt like, out of nowhere, it 326 00:19:59,119 --> 00:20:04,600 Speaker 1: stopped working. I'm reluctant to change medications, but sometimes I'll 327 00:20:04,640 --> 00:20:08,080 Speaker 1: change to like a sister or a cousin medication, or 328 00:20:08,080 --> 00:20:10,840 Speaker 1: I may think of adding something else from a different 329 00:20:10,880 --> 00:20:14,240 Speaker 1: class to sort of boost the effect of the original medication. 330 00:20:15,840 --> 00:20:19,800 Speaker 1: And how do you have conversations about your with your partner, 331 00:20:20,040 --> 00:20:25,280 Speaker 1: your family, your even children, sometimes about the potential side 332 00:20:25,280 --> 00:20:27,960 Speaker 1: effects of a new medication that you're trying. So some 333 00:20:28,119 --> 00:20:31,000 Speaker 1: of the things here are weight, gay and sexual dysfunction. 334 00:20:31,600 --> 00:20:35,879 Speaker 1: So I often try to normalize from my patients that 335 00:20:35,960 --> 00:20:38,440 Speaker 1: if you have high blood pressure, there's certain high blood 336 00:20:38,440 --> 00:20:42,000 Speaker 1: pressure medications that make you sensitive to sunlight, so you 337 00:20:42,000 --> 00:20:43,919 Speaker 1: know you have to wear sunscreen or you know you 338 00:20:43,960 --> 00:20:46,560 Speaker 1: can't lay out in the sun with your kids. Right, 339 00:20:47,359 --> 00:20:50,840 Speaker 1: Medications for mental health are similar in that way that 340 00:20:51,119 --> 00:20:56,320 Speaker 1: like they're related to biochemical changes in the body and 341 00:20:56,359 --> 00:20:59,800 Speaker 1: the brain, just like high blood pressure medications, just like 342 00:21:00,000 --> 00:21:04,320 Speaker 1: statins we use for to lower cholesterol. So I find 343 00:21:04,400 --> 00:21:07,600 Speaker 1: that when people understand that mental health issues are a 344 00:21:07,640 --> 00:21:11,159 Speaker 1: mind body issue, not just a mind or a spiritual issue, 345 00:21:11,720 --> 00:21:15,760 Speaker 1: then it helps people find their their grounding to have 346 00:21:15,840 --> 00:21:19,960 Speaker 1: conversations with other people. So I'd say the first thing 347 00:21:20,000 --> 00:21:23,040 Speaker 1: I say to people is and I asked them, like, 348 00:21:23,320 --> 00:21:26,080 Speaker 1: does your family know that you're on medication, and they'll say, 349 00:21:26,160 --> 00:21:27,960 Speaker 1: you know, I feel kind of funny telling them, and 350 00:21:28,000 --> 00:21:30,880 Speaker 1: then what makes you feel funny? Okay, your family may 351 00:21:30,880 --> 00:21:34,280 Speaker 1: see this as a spiritual failure that you are on medication. 352 00:21:34,320 --> 00:21:37,119 Speaker 1: Your family may see this as a weakness. Right, But 353 00:21:37,200 --> 00:21:39,320 Speaker 1: would they say that to you if you fell and 354 00:21:39,359 --> 00:21:42,439 Speaker 1: broke your ankle? Would they say if you only prayed harder, 355 00:21:42,800 --> 00:21:46,480 Speaker 1: your ankle would heal quicker or you wouldn't feel any 356 00:21:46,520 --> 00:21:51,080 Speaker 1: pain at all? M hm Right, So so we kind 357 00:21:51,080 --> 00:21:53,639 Speaker 1: of have to talk through some of the biases that 358 00:21:53,640 --> 00:21:56,119 Speaker 1: that we grew up with, and then we have to 359 00:21:56,200 --> 00:21:58,919 Speaker 1: talk through well what sorts of how do you shape 360 00:21:58,960 --> 00:22:03,359 Speaker 1: that conversation to honor your experience as somebody who is 361 00:22:03,440 --> 00:22:07,359 Speaker 1: dealing with a mind body issue, and how do you 362 00:22:07,400 --> 00:22:11,760 Speaker 1: simultaneously let them know. Look, after I take my medication 363 00:22:12,160 --> 00:22:14,359 Speaker 1: by nine PM, I need to be asleep. If I 364 00:22:14,400 --> 00:22:17,840 Speaker 1: have bipolar disorder, I have to sleep. So I need 365 00:22:17,880 --> 00:22:21,119 Speaker 1: help with the kids because if I don't get my sleep, 366 00:22:21,160 --> 00:22:23,399 Speaker 1: I might be at risk for a manic episode, and 367 00:22:23,480 --> 00:22:26,719 Speaker 1: those can be disastrous if I don't get the right 368 00:22:26,760 --> 00:22:28,760 Speaker 1: amount of sleep, or if I don't get the right nutrition. 369 00:22:29,720 --> 00:22:33,760 Speaker 1: While I deal with my depression, that could set me back, 370 00:22:33,880 --> 00:22:36,159 Speaker 1: and that's only going to make me feel worse. So 371 00:22:36,200 --> 00:22:38,720 Speaker 1: how can we make sure that we plan for the 372 00:22:38,720 --> 00:22:41,719 Speaker 1: things that I need to me? That's where you focus 373 00:22:41,800 --> 00:22:44,760 Speaker 1: the discussion. It doesn't have to be about personal weaknesses 374 00:22:44,800 --> 00:22:48,200 Speaker 1: and failures because that's not going to leave anybody feeling better. 375 00:22:48,600 --> 00:22:51,639 Speaker 1: So someone is dealing with a low sex drive because 376 00:22:51,680 --> 00:22:55,439 Speaker 1: of a medication that they're taking. Are you suggesting that 377 00:22:55,480 --> 00:22:58,520 Speaker 1: they take something else to help with that or what 378 00:22:58,760 --> 00:23:02,960 Speaker 1: is something that you commend? Yeah? So with with s 379 00:23:02,960 --> 00:23:06,880 Speaker 1: sr eyes, the class of antidepressants that we often use 380 00:23:06,960 --> 00:23:10,400 Speaker 1: for depression, there can be the potential for sexual side 381 00:23:10,400 --> 00:23:14,840 Speaker 1: effects and for women particularly. It can mean women and men, 382 00:23:14,960 --> 00:23:17,160 Speaker 1: but for women it can be hard because if we're 383 00:23:17,160 --> 00:23:22,159 Speaker 1: in a heterosexual relationship where the man is particularly focused 384 00:23:22,320 --> 00:23:28,679 Speaker 1: on achieving helping his partner achieve orgasm uh and he 385 00:23:28,840 --> 00:23:32,480 Speaker 1: is not comfortable using a toy to to help his 386 00:23:32,800 --> 00:23:36,800 Speaker 1: partner get there, it can leave the man feeling very 387 00:23:36,880 --> 00:23:40,800 Speaker 1: defeated and leave a woman feeling like orgasm lists right, 388 00:23:40,880 --> 00:23:44,080 Speaker 1: or as we say, an orgasmic. So in that case, 389 00:23:44,119 --> 00:23:45,960 Speaker 1: I do tell my patients ahead of time, like this 390 00:23:46,040 --> 00:23:49,280 Speaker 1: medication might help you with your depression but if sex 391 00:23:49,359 --> 00:23:50,920 Speaker 1: is the only thing you enjoy right now and you're 392 00:23:51,000 --> 00:23:53,320 Speaker 1: terribly depressed, maybe we need to think about another medication. 393 00:23:53,640 --> 00:23:56,400 Speaker 1: And I've had that conversation y'all with women in their 394 00:23:56,440 --> 00:24:00,520 Speaker 1: seventies and eighties. Okay, I have a seven be something 395 00:24:00,560 --> 00:24:03,520 Speaker 1: your old patient. We had to have her like take 396 00:24:03,560 --> 00:24:07,280 Speaker 1: a little break from her SSRR for a weekend because 397 00:24:07,280 --> 00:24:09,760 Speaker 1: she was like, I haven't had an orgasm in a decade. 398 00:24:10,440 --> 00:24:12,159 Speaker 1: She was like like, we're just gonna know each other, 399 00:24:12,200 --> 00:24:14,040 Speaker 1: but you should know I want an orgasm. And I 400 00:24:14,040 --> 00:24:17,359 Speaker 1: was like, girl, we're gonna get you your orgasm. And yes, ma'am. 401 00:24:17,440 --> 00:24:22,760 Speaker 1: She got her orgasm back and and then some. So yeah, 402 00:24:22,960 --> 00:24:25,080 Speaker 1: we tried to talk about those things. So whenever you 403 00:24:25,160 --> 00:24:27,440 Speaker 1: just said about stopping for a weekend, how do people 404 00:24:27,640 --> 00:24:31,359 Speaker 1: typically stop medications, Like let's say your insurance changes, or 405 00:24:31,760 --> 00:24:34,040 Speaker 1: you don't want to be on any whatever the reason is, 406 00:24:34,119 --> 00:24:37,800 Speaker 1: you become pregnant. How do you go about stopping a 407 00:24:37,840 --> 00:24:41,159 Speaker 1: medication even taking for a long amount of time. So 408 00:24:41,600 --> 00:24:46,960 Speaker 1: there's some medication there's particularly there's like one medication where 409 00:24:47,440 --> 00:24:49,480 Speaker 1: you just don't miss a dose. And so I would 410 00:24:49,480 --> 00:24:51,440 Speaker 1: just be very honest with you. It's called Venla vaccine. 411 00:24:51,440 --> 00:24:56,160 Speaker 1: It's also called effects her and it's really a lovely medication, 412 00:24:56,200 --> 00:24:59,119 Speaker 1: works very very well. Unfortunately, you miss a dose and 413 00:24:59,160 --> 00:25:01,720 Speaker 1: suddenly you feel like of the flu and a headache 414 00:25:01,720 --> 00:25:04,600 Speaker 1: and a migraine and all kinds of things. So you 415 00:25:04,680 --> 00:25:06,960 Speaker 1: just don't miss a dose. If you want to decrease, 416 00:25:08,040 --> 00:25:11,119 Speaker 1: we do it very very slowly, and there are times 417 00:25:11,119 --> 00:25:13,680 Speaker 1: where even we decrease and we get to a point 418 00:25:13,720 --> 00:25:16,480 Speaker 1: where when we stop at the person still has side effects, 419 00:25:16,560 --> 00:25:20,159 Speaker 1: so then or what we call discontinuation effects, and so 420 00:25:20,240 --> 00:25:22,959 Speaker 1: sometimes we will switch to something that lasts much longer 421 00:25:23,080 --> 00:25:26,639 Speaker 1: in the bloodstream, just to tie them over until we 422 00:25:26,680 --> 00:25:29,080 Speaker 1: get down to zero if they want to come off 423 00:25:29,119 --> 00:25:34,280 Speaker 1: all antidepressants, particularly that one. I mean again, do it slowly, 424 00:25:34,359 --> 00:25:36,240 Speaker 1: and if we need to we switch to something else. 425 00:25:37,240 --> 00:25:41,600 Speaker 1: How long do like, is it normal for someone to 426 00:25:41,760 --> 00:25:47,080 Speaker 1: be on a medication for thirty years or is like 427 00:25:47,119 --> 00:25:51,439 Speaker 1: an antidepressant or something for anxiety is something that you 428 00:25:51,520 --> 00:25:54,800 Speaker 1: typically will be on for a while, work with a therapist, 429 00:25:54,880 --> 00:25:57,880 Speaker 1: and then at some point you know. So it depends 430 00:25:58,280 --> 00:26:01,120 Speaker 1: on the severity of the depression and how many episodes 431 00:26:01,160 --> 00:26:04,440 Speaker 1: of depression the person has had. Because there's some really 432 00:26:04,480 --> 00:26:12,159 Speaker 1: good data to show that one episode of depression means. 433 00:26:11,040 --> 00:26:13,560 Speaker 1: I like the first thing I'm gonna say, it's like, 434 00:26:13,560 --> 00:26:16,520 Speaker 1: go for psychotherapy. If you need medication, I'm here. If 435 00:26:16,560 --> 00:26:21,520 Speaker 1: you're on medication and psychotherapy and you experience a remission 436 00:26:21,680 --> 00:26:24,400 Speaker 1: of symptoms, then I will say I at least want 437 00:26:24,400 --> 00:26:27,600 Speaker 1: to give this six months to work and to just 438 00:26:27,800 --> 00:26:33,639 Speaker 1: see how life is with medication. And because untreated depression, 439 00:26:34,840 --> 00:26:40,120 Speaker 1: every episode of untreated depression leaves a person more vulnerable, 440 00:26:40,640 --> 00:26:46,080 Speaker 1: too harder to treat depression in the future, and at 441 00:26:46,200 --> 00:26:52,880 Speaker 1: risk for cognitive impairment in tiny ways. But I think 442 00:26:53,400 --> 00:26:57,439 Speaker 1: I can't underscore this enough. That depression is a mind 443 00:26:57,560 --> 00:27:01,480 Speaker 1: body issue, and so I try to make sure that 444 00:27:01,520 --> 00:27:05,520 Speaker 1: people understand that every episode of depression needs to be treated, 445 00:27:05,600 --> 00:27:09,600 Speaker 1: either with psychotherapy or with medication, or the combination of both. 446 00:27:11,000 --> 00:27:14,640 Speaker 1: Just don't leave it untreated. For most people, any episode 447 00:27:14,640 --> 00:27:19,480 Speaker 1: of depression will probably end after one year, but if 448 00:27:19,520 --> 00:27:23,440 Speaker 1: it doesn't, it really really needs to be treated. And 449 00:27:23,480 --> 00:27:27,720 Speaker 1: so if somebody has had more than two episodes of depression, right, 450 00:27:27,800 --> 00:27:30,040 Speaker 1: if we say the first episode of depression happened, you 451 00:27:30,080 --> 00:27:32,560 Speaker 1: stayed on your medication for six months, you stayed in 452 00:27:32,600 --> 00:27:35,840 Speaker 1: therapy for six months. Okay, fine, if you really want 453 00:27:35,840 --> 00:27:38,200 Speaker 1: to drop us all and go live life, that's fine. 454 00:27:39,040 --> 00:27:41,760 Speaker 1: You come back to me with a second episode of depression. 455 00:27:41,840 --> 00:27:43,760 Speaker 1: I want you to stay on medication for a year 456 00:27:44,160 --> 00:27:47,760 Speaker 1: and be in therapy if you're willing. If you stop 457 00:27:47,800 --> 00:27:49,520 Speaker 1: it after a year and then come back to me 458 00:27:49,560 --> 00:27:53,000 Speaker 1: with a third episode of depression, I will recommend that 459 00:27:53,000 --> 00:27:55,040 Speaker 1: you stay on medication for the rest of your life, 460 00:27:56,119 --> 00:28:00,760 Speaker 1: because every episode of untreated depression leaves a person at 461 00:28:00,880 --> 00:28:04,320 Speaker 1: higher risk for depression in the future that may be 462 00:28:04,520 --> 00:28:08,879 Speaker 1: harder to treat, and they may have residual symptoms of 463 00:28:09,320 --> 00:28:13,239 Speaker 1: some cognitive impairment. So someone is in the process of 464 00:28:13,280 --> 00:28:17,480 Speaker 1: trying to get pregnant, do you adjust their dosage? Do 465 00:28:17,560 --> 00:28:20,640 Speaker 1: you guys talk about what that looks like once they're pregnant, 466 00:28:20,960 --> 00:28:26,320 Speaker 1: And does any medication they're prescribing have effects on fertility 467 00:28:26,359 --> 00:28:34,240 Speaker 1: and unborned babies? So when it comes to pregnancy and fertility, 468 00:28:34,760 --> 00:28:39,760 Speaker 1: so I'll start off with fertility. So no, I believe 469 00:28:40,040 --> 00:28:44,760 Speaker 1: that in each of the medications that we prescribe for 470 00:28:44,920 --> 00:28:48,120 Speaker 1: any mental health disorder, I do not believe any of 471 00:28:48,160 --> 00:28:54,959 Speaker 1: them can impair fertility. There's some antipsychotics that may affect periods, 472 00:28:55,120 --> 00:28:59,760 Speaker 1: but it's super duper extremely extremely rare, and so for 473 00:28:59,840 --> 00:29:01,880 Speaker 1: that matter, like we just try to think, Okay, this 474 00:29:02,000 --> 00:29:05,360 Speaker 1: person's of childbearing age and they are perhaps likely to 475 00:29:05,360 --> 00:29:08,479 Speaker 1: be pregnant because they're not on a contraceptive. So then 476 00:29:08,520 --> 00:29:10,840 Speaker 1: we'll just think, okay, if this person does get pregnant, 477 00:29:10,880 --> 00:29:16,040 Speaker 1: we will immediately stop certain medications. There's one antidepressant, particularly 478 00:29:17,040 --> 00:29:21,080 Speaker 1: taxel paroxytine, that we try to make sure that people 479 00:29:21,120 --> 00:29:24,120 Speaker 1: are not on when they're pregnant. They're also medications for 480 00:29:24,120 --> 00:29:28,040 Speaker 1: seizure disorders and for bipolar disorder that have been shown 481 00:29:28,080 --> 00:29:31,400 Speaker 1: to be what we call tarratogenic that can affect the 482 00:29:31,440 --> 00:29:35,160 Speaker 1: spine of the baby and perhaps be related to some 483 00:29:35,280 --> 00:29:39,200 Speaker 1: growth abnormalities as well, So we keep those things in 484 00:29:39,280 --> 00:29:45,080 Speaker 1: mind for sure, But overall, SSR EYES antidepressants, like from 485 00:29:45,080 --> 00:29:47,360 Speaker 1: the s s R I class have been shown to 486 00:29:47,400 --> 00:29:53,040 Speaker 1: be like fine, particularly in in when we're weighing the 487 00:29:53,200 --> 00:29:57,600 Speaker 1: risk of depression or a depressive illness with the risk 488 00:29:58,240 --> 00:30:00,360 Speaker 1: to the baby. Like so the risk to the other's 489 00:30:00,360 --> 00:30:03,520 Speaker 1: health sometimes versus the risk to the baby, and so 490 00:30:03,720 --> 00:30:07,680 Speaker 1: usually we'll just say this mom needs to stay in 491 00:30:07,800 --> 00:30:12,440 Speaker 1: therapy and on medication because they may have a history 492 00:30:12,440 --> 00:30:16,360 Speaker 1: of suicidality, they may have a history of psychosis. And 493 00:30:16,440 --> 00:30:19,000 Speaker 1: I am not here to say that folks who have 494 00:30:19,040 --> 00:30:22,360 Speaker 1: dealt with mental disorders should not have children, do you 495 00:30:22,400 --> 00:30:25,240 Speaker 1: know what I'm saying. So I'm out here like you 496 00:30:25,280 --> 00:30:27,560 Speaker 1: want to have this baby. We're gonna have this baby. 497 00:30:27,600 --> 00:30:29,400 Speaker 1: This is gonna be the people's baby, and we're gonna 498 00:30:29,400 --> 00:30:32,120 Speaker 1: do this. But I need to make sure that that again, 499 00:30:32,160 --> 00:30:35,040 Speaker 1: you're not gonna hurt yourself, and that the most important 500 00:30:35,040 --> 00:30:37,000 Speaker 1: thing is that when your baby is born, you are 501 00:30:37,040 --> 00:30:40,760 Speaker 1: present enough to take care of this baby. More from 502 00:30:40,800 --> 00:30:54,000 Speaker 1: our conversation with Dr Glover after the break. I would 503 00:30:54,040 --> 00:30:57,120 Speaker 1: love to know who would you say is a good 504 00:30:57,160 --> 00:31:02,440 Speaker 1: candidate for getting psychotropic medications and then who is maybe 505 00:31:02,720 --> 00:31:05,280 Speaker 1: not so good of a candidate. It's a few things. 506 00:31:05,320 --> 00:31:08,760 Speaker 1: So it depends on what the underlying disorder is. So 507 00:31:08,880 --> 00:31:12,880 Speaker 1: if we're talking about depression, if the person is not 508 00:31:13,040 --> 00:31:16,560 Speaker 1: motivated for therapy, then I'm going to think, Okay, how 509 00:31:16,560 --> 00:31:19,280 Speaker 1: severe is the depression? Like if I can just say, 510 00:31:19,320 --> 00:31:24,920 Speaker 1: like exercise and take long baths and pray and read 511 00:31:24,960 --> 00:31:28,080 Speaker 1: inspirational books, then I'll say that. But often by the 512 00:31:28,080 --> 00:31:30,520 Speaker 1: time people get to me, it's because they've tried all 513 00:31:30,560 --> 00:31:34,680 Speaker 1: of those things and it hasn't been quite enough. So 514 00:31:35,160 --> 00:31:37,800 Speaker 1: from there, if they are motivated to take a medication, 515 00:31:37,880 --> 00:31:39,680 Speaker 1: or even if they are not so motivated, but they're 516 00:31:39,720 --> 00:31:44,040 Speaker 1: willing to at least try taking medication three four times 517 00:31:44,040 --> 00:31:46,360 Speaker 1: a week, right, because I'm not there. I'm not gonna 518 00:31:46,400 --> 00:31:49,320 Speaker 1: be feeding it to the person every morning. So I know, right, 519 00:31:49,640 --> 00:31:51,560 Speaker 1: we as humans, we don't. I don't even take my 520 00:31:51,680 --> 00:31:56,280 Speaker 1: vitamins every day, right, So if they are willing to try, 521 00:31:56,480 --> 00:31:59,560 Speaker 1: I'm willing to meet them there. And so that person 522 00:31:59,800 --> 00:32:03,040 Speaker 1: is a fine candidate to take and to try medications. 523 00:32:04,160 --> 00:32:06,320 Speaker 1: Will I give them the thing that if they miss 524 00:32:06,320 --> 00:32:08,080 Speaker 1: a day they have horrible headaches and feel like they're 525 00:32:08,120 --> 00:32:10,560 Speaker 1: coming down with COVID. No, I'm going to give them 526 00:32:10,560 --> 00:32:13,760 Speaker 1: a medication that probably will last in their system for three, 527 00:32:13,880 --> 00:32:18,200 Speaker 1: four or five days. For example, prozac or fluoxitine. It 528 00:32:18,320 --> 00:32:20,840 Speaker 1: stays in the system for days, so if you miss 529 00:32:20,840 --> 00:32:24,320 Speaker 1: a day, you won't feel any different. That's one thing 530 00:32:24,360 --> 00:32:26,600 Speaker 1: I've taken to account. How likely is the person to 531 00:32:26,680 --> 00:32:30,440 Speaker 1: remain adherent to the medication? Thank you? Do you have 532 00:32:30,480 --> 00:32:34,320 Speaker 1: any advice for someone who's like struggling to accept that 533 00:32:34,400 --> 00:32:38,800 Speaker 1: they need to be on a medication for a long time. Yeah, 534 00:32:39,280 --> 00:32:43,440 Speaker 1: I think often it's a conversation. So it starts with 535 00:32:44,000 --> 00:32:47,959 Speaker 1: what's the hardest thing about accepting this? And then sometimes 536 00:32:48,000 --> 00:32:50,000 Speaker 1: it has to go back to what were you taught 537 00:32:50,560 --> 00:32:53,040 Speaker 1: about depression growing up? Or what were you taught about 538 00:32:53,200 --> 00:32:55,640 Speaker 1: mental health growing up? And if you were taught that 539 00:32:55,720 --> 00:32:57,960 Speaker 1: it's a sign of weakness or that it's a sign 540 00:32:58,480 --> 00:33:02,840 Speaker 1: that it's only for people need to be in institutions, right, 541 00:33:02,880 --> 00:33:06,600 Speaker 1: that there's no spectrum of disorders, there's no spectrum of 542 00:33:06,680 --> 00:33:10,600 Speaker 1: symptom severity. That there's only either you're you know, got 543 00:33:10,680 --> 00:33:14,960 Speaker 1: to pop in Instagram page or you are in uh in, 544 00:33:15,120 --> 00:33:17,959 Speaker 1: locked up in in the impatient unit. Then we need 545 00:33:18,000 --> 00:33:19,680 Speaker 1: to talk about, you know, sort of like getting away 546 00:33:19,680 --> 00:33:21,760 Speaker 1: from black and white thinking, and we need to think 547 00:33:21,800 --> 00:33:25,320 Speaker 1: about that there's a whole set of ways to live 548 00:33:25,840 --> 00:33:30,720 Speaker 1: with a mental health disorder. And then from there it's 549 00:33:30,760 --> 00:33:32,840 Speaker 1: really not something you have to accept for your whole life. 550 00:33:32,840 --> 00:33:34,760 Speaker 1: You just have to accept it every morning when you 551 00:33:34,800 --> 00:33:37,360 Speaker 1: take your medication or every night before you go to bed. Right, 552 00:33:37,800 --> 00:33:41,400 Speaker 1: there's plenty of things that people wish they could change 553 00:33:41,400 --> 00:33:45,120 Speaker 1: about their bodies and their health. And yet that's where 554 00:33:45,240 --> 00:33:48,200 Speaker 1: to me mindfulness comes in as well as an extra 555 00:33:48,240 --> 00:33:52,640 Speaker 1: way to to just learn how to not judge and 556 00:33:52,680 --> 00:33:56,080 Speaker 1: to remain committed to yourself. I'm not even sure if 557 00:33:56,120 --> 00:33:58,720 Speaker 1: you get responses, But if you're able to have a 558 00:33:58,760 --> 00:34:01,680 Speaker 1: family member who had a bad experience of medication and 559 00:34:01,720 --> 00:34:03,640 Speaker 1: you feel like they would benefit from being on it, 560 00:34:04,120 --> 00:34:07,360 Speaker 1: how would you encourage them to do that? Yeah? I 561 00:34:07,360 --> 00:34:12,680 Speaker 1: mean I would wonder what happened? Meaning was it the 562 00:34:12,719 --> 00:34:16,200 Speaker 1: relationship they had with the prescriber? Was it the side 563 00:34:16,200 --> 00:34:19,440 Speaker 1: effects that they had? Because often, right, I'll prescribe a 564 00:34:19,520 --> 00:34:22,880 Speaker 1: medication and the patient doesn't really like it. The thing is, 565 00:34:23,080 --> 00:34:25,759 Speaker 1: I try to set it up where people know that 566 00:34:25,840 --> 00:34:27,880 Speaker 1: they can come back and tell me I act to 567 00:34:27,920 --> 00:34:29,759 Speaker 1: globor I didn't like this medication. You gotta give me 568 00:34:29,800 --> 00:34:32,760 Speaker 1: something else. And people do that all the time, right 569 00:34:33,200 --> 00:34:36,319 Speaker 1: and so right, because I can't promise that if I 570 00:34:36,560 --> 00:34:39,279 Speaker 1: offer you, like grilled cheese, that you're gonna like it, 571 00:34:39,360 --> 00:34:41,120 Speaker 1: you can say like, I didn't really like that. Can 572 00:34:41,160 --> 00:34:44,440 Speaker 1: I get something else? It's fine? So I do wonder 573 00:34:44,680 --> 00:34:50,680 Speaker 1: whether that person's prescriber was open enough. Right, So, assuming 574 00:34:50,680 --> 00:34:53,040 Speaker 1: the prescriber was open and said, please come back and 575 00:34:53,080 --> 00:34:56,440 Speaker 1: tell me if this medication doesn't agree with you, and 576 00:34:56,680 --> 00:34:58,800 Speaker 1: I will work with you to manage the side effects. 577 00:34:58,800 --> 00:35:01,759 Speaker 1: So for some people, they try a medication that I 578 00:35:01,800 --> 00:35:04,799 Speaker 1: think will not make them sedated, so I will say 579 00:35:04,840 --> 00:35:06,680 Speaker 1: it's probably better to take it during the day. Well, 580 00:35:06,719 --> 00:35:08,279 Speaker 1: and do I know every human on earth and how 581 00:35:08,400 --> 00:35:11,560 Speaker 1: medication is gonna affect them. No, So some people say, hey, 582 00:35:11,680 --> 00:35:14,600 Speaker 1: I took your medication during the morning and I slept 583 00:35:14,600 --> 00:35:17,319 Speaker 1: the whole day. Well, guess what, We're gonna take it 584 00:35:17,320 --> 00:35:20,200 Speaker 1: at night this time? Right, Please tomorrow, try taking it 585 00:35:20,239 --> 00:35:22,600 Speaker 1: at night and take it at six pm so that 586 00:35:22,719 --> 00:35:24,880 Speaker 1: by the time you wake up the sedative effects have 587 00:35:24,920 --> 00:35:27,359 Speaker 1: worn off and you're not groggy. I really do try 588 00:35:27,360 --> 00:35:30,719 Speaker 1: to have that conversation with people and just say, just 589 00:35:30,840 --> 00:35:33,000 Speaker 1: because you took it for a couple of nights and 590 00:35:33,040 --> 00:35:34,840 Speaker 1: it made you feel weird, that doesn't mean we have 591 00:35:34,920 --> 00:35:37,440 Speaker 1: to throw it away. It just means we need to 592 00:35:37,480 --> 00:35:40,680 Speaker 1: adjust when and how you take it. So there's an 593 00:35:40,680 --> 00:35:44,000 Speaker 1: antidepressant that we also used to prevent migraines. It's called 594 00:35:44,040 --> 00:35:46,120 Speaker 1: am a trip de line. So I have chronic migraines. 595 00:35:46,480 --> 00:35:49,759 Speaker 1: I took am a trip delane ten tiny little milligrams. 596 00:35:50,080 --> 00:35:52,200 Speaker 1: When I tell you, I woke up the next morning, 597 00:35:52,239 --> 00:35:55,560 Speaker 1: I had slept for thirteen hours, and I sat on 598 00:35:55,600 --> 00:35:57,680 Speaker 1: the edge of my bed and I was like, where 599 00:35:57,800 --> 00:36:01,520 Speaker 1: am I and I am? Vision was blurry, and I 600 00:36:01,600 --> 00:36:03,440 Speaker 1: was like, these are all the side effects I learned 601 00:36:03,440 --> 00:36:06,319 Speaker 1: about in medical school, and they're all happening to me 602 00:36:06,560 --> 00:36:09,400 Speaker 1: right now. And then I learned, Okay, I need to 603 00:36:09,840 --> 00:36:13,880 Speaker 1: a try this medication on a weekend, right, not on 604 00:36:13,920 --> 00:36:17,360 Speaker 1: a Sunday night before my big presentation on a Monday. 605 00:36:17,440 --> 00:36:19,600 Speaker 1: So we try the medication over the weekend, see how 606 00:36:19,719 --> 00:36:23,000 Speaker 1: it feels if you're not working, and then we have 607 00:36:23,040 --> 00:36:25,360 Speaker 1: a sense of how you'll feel Monday morning. Right, but 608 00:36:25,400 --> 00:36:27,040 Speaker 1: give yourself a few days to figure it out. So 609 00:36:27,080 --> 00:36:29,520 Speaker 1: those are some of the things and techniques that I 610 00:36:29,600 --> 00:36:32,160 Speaker 1: use to just sort of help people navigate. And again, 611 00:36:32,960 --> 00:36:34,719 Speaker 1: just this is something I wanted to stay related to 612 00:36:34,719 --> 00:36:37,759 Speaker 1: sexual side effects. There are some antidepressants that are not 613 00:36:37,800 --> 00:36:41,520 Speaker 1: associated with sexual side effects, so I'll just go towards 614 00:36:41,520 --> 00:36:43,719 Speaker 1: those and stay away from some of the other ones 615 00:36:43,760 --> 00:36:48,160 Speaker 1: that have potential sexual side effects. The idea wonder like, 616 00:36:48,200 --> 00:36:51,800 Speaker 1: how are you deciding which ones you feel most comfortable 617 00:36:51,800 --> 00:36:55,960 Speaker 1: with prescribing. Yeah, so I think about price. So I 618 00:36:56,000 --> 00:36:57,600 Speaker 1: think about this person if they're going to be using 619 00:36:57,640 --> 00:37:01,080 Speaker 1: insurance right and in the likelihood of their insurance covering it. 620 00:37:02,080 --> 00:37:04,000 Speaker 1: So just like somebody put in the chat, doesn't depend 621 00:37:04,040 --> 00:37:06,840 Speaker 1: on the formulary. So if their insurance says, we only 622 00:37:06,880 --> 00:37:10,400 Speaker 1: cover this formulation of this medication, we're not going to 623 00:37:10,600 --> 00:37:13,960 Speaker 1: cover the one that's long lasting because that one is 624 00:37:13,960 --> 00:37:16,399 Speaker 1: still under patent. So you can you can only give 625 00:37:16,440 --> 00:37:19,319 Speaker 1: the version that is twice a day. Well, then I 626 00:37:19,320 --> 00:37:21,640 Speaker 1: have to think, Okay, is this insurance only covers the 627 00:37:21,760 --> 00:37:24,200 Speaker 1: formulation for twice a day dosing. How likely is this 628 00:37:24,239 --> 00:37:26,560 Speaker 1: person going to take this medication twice a day? So 629 00:37:26,600 --> 00:37:28,960 Speaker 1: I really try to get to know the patient right 630 00:37:29,000 --> 00:37:31,320 Speaker 1: in their lifestyle. If I know this person is homeless 631 00:37:31,400 --> 00:37:35,280 Speaker 1: or or unhoused, for example, do I want to send 632 00:37:35,280 --> 00:37:37,520 Speaker 1: them off with a medication that's going to knock them 633 00:37:37,520 --> 00:37:41,200 Speaker 1: out completely at night and perhaps leave them vulnerable to 634 00:37:41,560 --> 00:37:44,520 Speaker 1: assault if they are if they are so heavily sedated 635 00:37:44,560 --> 00:37:46,959 Speaker 1: in a place where they're not safe. So I really 636 00:37:47,000 --> 00:37:49,440 Speaker 1: just try to customize it, is my point. If I 637 00:37:49,480 --> 00:37:51,880 Speaker 1: know that somebody is in a relationship, or if I 638 00:37:51,960 --> 00:37:54,840 Speaker 1: know that for this person their orgasms are incredibly important, 639 00:37:54,960 --> 00:37:56,560 Speaker 1: I will bear that in mind and say we're not 640 00:37:56,600 --> 00:37:58,839 Speaker 1: going to use the medications that are gonna that are 641 00:37:58,880 --> 00:38:03,799 Speaker 1: associated it delayed orgasm. For example, if I know the 642 00:38:03,800 --> 00:38:06,960 Speaker 1: person is struggling with weight, either their appetite is too low, 643 00:38:07,000 --> 00:38:09,840 Speaker 1: where their appetite is too high, then I'll think about 644 00:38:09,880 --> 00:38:16,040 Speaker 1: medications that sometimes stimulate appetite or medications that turn off appetite, 645 00:38:16,440 --> 00:38:19,359 Speaker 1: because there are those exist that was really well fit. 646 00:38:19,880 --> 00:38:23,000 Speaker 1: So if you're psychiatrist and says you know what, I've 647 00:38:23,000 --> 00:38:25,719 Speaker 1: heard what you said, I think you are dealing with this, 648 00:38:26,080 --> 00:38:28,320 Speaker 1: and they want to prescribe you something, is it possible 649 00:38:28,320 --> 00:38:29,879 Speaker 1: for you to say like, no, I don't think that's 650 00:38:29,880 --> 00:38:31,920 Speaker 1: what it is. I want to be treated for this instead. 651 00:38:33,080 --> 00:38:37,160 Speaker 1: Oh that's pretty rare. I will honestly say, it's pretty 652 00:38:37,239 --> 00:38:40,600 Speaker 1: rare for a patient to disagree with my diagnosis, mostly 653 00:38:40,640 --> 00:38:43,680 Speaker 1: because I review the symptoms like, okay, so you are 654 00:38:43,719 --> 00:38:47,360 Speaker 1: telling me, if I understand correctly, you are having difficulty 655 00:38:47,400 --> 00:38:51,160 Speaker 1: falling asleep, You're feeling hopeless, having feelings of low self worth, 656 00:38:51,360 --> 00:38:54,560 Speaker 1: and you have no appetite, and sometimes you think about 657 00:38:54,600 --> 00:38:58,879 Speaker 1: hurting yourself. That's that's depression, right, five of the nine 658 00:38:58,880 --> 00:39:03,920 Speaker 1: symptoms that as depression. Could it be more than depression, Absolutely, 659 00:39:03,920 --> 00:39:08,239 Speaker 1: it could be depression and trauma right, complex trauma or PTSD. 660 00:39:09,120 --> 00:39:12,759 Speaker 1: So in some ways, the people do come to me 661 00:39:12,840 --> 00:39:16,200 Speaker 1: sometimes and say I think I'm bipolar, and when I 662 00:39:16,239 --> 00:39:18,040 Speaker 1: listened to them some more, it turns out to be 663 00:39:18,040 --> 00:39:25,520 Speaker 1: a combination of emotional disregulation, but not by polar disorder proper. 664 00:39:26,200 --> 00:39:28,560 Speaker 1: So sometimes people who grow up with a history of trauma, 665 00:39:28,600 --> 00:39:32,400 Speaker 1: either a childhood sexual abuse or physical assault, or they 666 00:39:32,400 --> 00:39:34,719 Speaker 1: grow up in around lots of chaos and people who 667 00:39:34,760 --> 00:39:37,560 Speaker 1: don't know how to communicate through conflict in an effective, 668 00:39:37,600 --> 00:39:41,200 Speaker 1: healthy way, they may have trouble regulating their emotions. That 669 00:39:41,280 --> 00:39:44,000 Speaker 1: doesn't mean you're bipolar. It just means you haven't learned 670 00:39:44,000 --> 00:39:46,359 Speaker 1: how to regulate your emotions, and we need to work 671 00:39:46,400 --> 00:39:50,120 Speaker 1: on that in therapy and with medication. But I definitely 672 00:39:50,160 --> 00:39:52,640 Speaker 1: had people who said I don't want to take that medication. 673 00:39:52,719 --> 00:39:55,399 Speaker 1: I know people who have taken that and I don't 674 00:39:55,400 --> 00:39:58,600 Speaker 1: want to take it. And then sometimes it's a matter 675 00:39:58,640 --> 00:40:01,000 Speaker 1: of they will be and say I want to take 676 00:40:01,040 --> 00:40:04,080 Speaker 1: adderall or I want to take xanax, and I'm like, well, 677 00:40:04,120 --> 00:40:07,160 Speaker 1: that has an incredible street value, and so that's interesting 678 00:40:07,239 --> 00:40:09,680 Speaker 1: that you asked specifically for that. Can we talk about that? 679 00:40:10,080 --> 00:40:13,799 Speaker 1: So some people are seeking medication to sell or to 680 00:40:14,080 --> 00:40:17,160 Speaker 1: become intoxicated, but if somebody is willing to take something, 681 00:40:17,200 --> 00:40:21,520 Speaker 1: and we usually can find some sort of agreement. Yeah, 682 00:40:21,560 --> 00:40:24,239 Speaker 1: whenever you were talking to the beginning about just the 683 00:40:24,280 --> 00:40:28,440 Speaker 1: media in general glorifying just the you know, I think 684 00:40:28,480 --> 00:40:30,920 Speaker 1: of a movie that was watching recently, the mom like 685 00:40:31,000 --> 00:40:33,360 Speaker 1: sitting at the game and she just like starts popping 686 00:40:33,360 --> 00:40:36,480 Speaker 1: stuff and she's like, I gotta get through this. And 687 00:40:36,600 --> 00:40:38,560 Speaker 1: I think, like a lot of times in the media, 688 00:40:39,000 --> 00:40:41,600 Speaker 1: that can itself be a negative effect and make people 689 00:40:41,680 --> 00:40:44,120 Speaker 1: think like, oh, that's not what I'm trying to do here. 690 00:40:44,520 --> 00:40:47,080 Speaker 1: So I love that you address that, and hopefully these 691 00:40:47,120 --> 00:40:49,560 Speaker 1: types of conversations will just kind of get rid of 692 00:40:49,600 --> 00:40:52,799 Speaker 1: that stigma and let people know that that's that's not 693 00:40:53,840 --> 00:40:57,719 Speaker 1: the reality of it. Yeah, for sure, that's definitely been 694 00:40:57,760 --> 00:41:01,800 Speaker 1: one of the more disheartening parts of ingesting media and 695 00:41:01,800 --> 00:41:05,000 Speaker 1: and some of the TV and film it's like gets 696 00:41:05,040 --> 00:41:11,400 Speaker 1: totally misrepresented. What about CBD non psychoactive extracts for occasional 697 00:41:11,480 --> 00:41:16,520 Speaker 1: bouts of anxiety and depression. So there's not a ton 698 00:41:16,640 --> 00:41:21,480 Speaker 1: of great evidence about CBD. So I've heard lots of 699 00:41:21,520 --> 00:41:26,279 Speaker 1: anecdotal evidence, but there haven't been really good I mean, right, 700 00:41:26,320 --> 00:41:32,399 Speaker 1: the gold standard in medicine is randomized, placebo controlled trials 701 00:41:32,440 --> 00:41:37,960 Speaker 1: to assess a CBD tincture versus one that doesn't contain 702 00:41:38,080 --> 00:41:41,200 Speaker 1: CBD but looks like it does, and giving that to 703 00:41:41,360 --> 00:41:45,160 Speaker 1: people who are struggling with depression or anxiety, and then 704 00:41:45,239 --> 00:41:48,560 Speaker 1: measuring that for twelve weeks. That would be the gold standard. 705 00:41:49,280 --> 00:41:53,800 Speaker 1: Those trials are not abundant. So there's just not enough evidence. 706 00:41:53,840 --> 00:41:56,799 Speaker 1: So to me, if somebody tells me like, look, I 707 00:41:56,840 --> 00:41:59,960 Speaker 1: swear by my CBD, I'm like, look whatever, I'll we're 708 00:42:00,080 --> 00:42:02,200 Speaker 1: with you. If somebody tells me, look, do not come 709 00:42:02,239 --> 00:42:05,600 Speaker 1: between me and my cannabis, right, or I have people 710 00:42:05,600 --> 00:42:09,799 Speaker 1: in a medical cannabis program here at our hospital system, 711 00:42:09,880 --> 00:42:12,399 Speaker 1: And so for the most part, I just think, like, look, 712 00:42:12,520 --> 00:42:16,399 Speaker 1: if you're CBD products, or if your cannabis products are 713 00:42:16,520 --> 00:42:19,719 Speaker 1: enhancing your life in ways that are helping you live 714 00:42:19,760 --> 00:42:21,880 Speaker 1: your best life, I'm not going to stand in the 715 00:42:21,920 --> 00:42:24,239 Speaker 1: way of that. But if there are other things that 716 00:42:24,360 --> 00:42:27,640 Speaker 1: still need to be treated, I'm here for that too, perfect. 717 00:42:27,680 --> 00:42:30,880 Speaker 1: So I just want to close off with one more question. So, 718 00:42:31,120 --> 00:42:35,000 Speaker 1: someone who means to continue with their medication or needs 719 00:42:35,000 --> 00:42:37,279 Speaker 1: to take a pause or whatever that is, Like, what 720 00:42:37,520 --> 00:42:41,279 Speaker 1: steps do you advise people to take whenever they find 721 00:42:41,280 --> 00:42:43,760 Speaker 1: themselves in a situation where they don't have the insurance 722 00:42:43,800 --> 00:42:47,480 Speaker 1: to cover sometimes these really really expensive drugs. Yeah, so 723 00:42:47,520 --> 00:42:50,040 Speaker 1: sometimes I'll suggest they go to good r X. And 724 00:42:50,120 --> 00:42:55,240 Speaker 1: so good r x dot com helps you locate which 725 00:42:55,280 --> 00:42:58,839 Speaker 1: pharmacies carry the medication that you want, and you can 726 00:42:58,920 --> 00:43:01,759 Speaker 1: gauge how much it will cost you, and often you 727 00:43:01,800 --> 00:43:05,279 Speaker 1: can get it for much lower prices than if you 728 00:43:05,320 --> 00:43:07,319 Speaker 1: didn't check good r X. Like you can literally print 729 00:43:07,320 --> 00:43:09,719 Speaker 1: out a coupon from good r X, bring it to 730 00:43:09,719 --> 00:43:12,000 Speaker 1: the pharmacy, and you will pay for the medication, but 731 00:43:12,040 --> 00:43:14,600 Speaker 1: it will be at a at a significant discount. Thank 732 00:43:14,640 --> 00:43:17,880 Speaker 1: you so much. This was a welcome information. Can you 733 00:43:17,960 --> 00:43:20,600 Speaker 1: let everyone know how to get in contact with you. 734 00:43:21,239 --> 00:43:24,400 Speaker 1: My Instagram is I'm at dr karrin So that's d 735 00:43:24,600 --> 00:43:28,239 Speaker 1: r k a r i n n. On social media, 736 00:43:28,280 --> 00:43:31,800 Speaker 1: on Twitter, on Instagram, on Facebook, I'm doctor so d 737 00:43:32,080 --> 00:43:35,280 Speaker 1: r k a r i n n. Dr karn Glover 738 00:43:35,480 --> 00:43:38,600 Speaker 1: on Facebook. I will also say there's a lot of 739 00:43:38,640 --> 00:43:42,800 Speaker 1: black women psychiatrists and black male psychiatrists who are trying 740 00:43:42,840 --> 00:43:48,360 Speaker 1: to teach our colleagues from other backgrounds how to do better. 741 00:43:49,280 --> 00:43:51,160 Speaker 1: And so I just I want you all to pray 742 00:43:51,200 --> 00:43:54,520 Speaker 1: for us, and I also want you to to be 743 00:43:54,600 --> 00:43:58,520 Speaker 1: aware that the medical field as a whole is undergoing 744 00:43:58,560 --> 00:44:02,520 Speaker 1: massive changes. In psychiatry in particular, I think people are 745 00:44:02,600 --> 00:44:07,720 Speaker 1: really trying to understand better how to not have racial 746 00:44:07,760 --> 00:44:12,600 Speaker 1: trauma play out in the medical setting. By to hear that, well, 747 00:44:12,640 --> 00:44:18,000 Speaker 1: thank you again for being here with us. I'm so 748 00:44:18,120 --> 00:44:21,600 Speaker 1: grateful Dr Glover joined us for that conversation and for 749 00:44:21,719 --> 00:44:24,920 Speaker 1: Jasmine for doing such a great job facilitating it. To 750 00:44:25,000 --> 00:44:27,600 Speaker 1: learn more about Dr Glover and her work, be sure 751 00:44:27,640 --> 00:44:30,000 Speaker 1: to visit the show notes at Therapy for Black Girls 752 00:44:30,040 --> 00:44:33,480 Speaker 1: dot Com slash Session two to one, and don't forget 753 00:44:33,480 --> 00:44:36,120 Speaker 1: to text two of your girls right now and tell 754 00:44:36,200 --> 00:44:38,719 Speaker 1: them to check out the episode as well. If you're 755 00:44:38,760 --> 00:44:41,320 Speaker 1: looking for a therapist in your area, be sure to 756 00:44:41,400 --> 00:44:44,320 Speaker 1: check out our therapist directory at Therapy for Black Girls 757 00:44:44,360 --> 00:44:47,640 Speaker 1: dot com slash directory. And if you want to continue 758 00:44:47,680 --> 00:44:51,320 Speaker 1: digging into this topic or just being community with other sisters, 759 00:44:51,719 --> 00:44:53,800 Speaker 1: come on over and join us in the Sister Circle. 760 00:44:54,239 --> 00:44:56,640 Speaker 1: It's our cozy corner of the Internet, design just for 761 00:44:56,680 --> 00:44:59,960 Speaker 1: black women. You can join us at community dot therapy 762 00:45:00,000 --> 00:45:03,160 Speaker 1: for black girls dot com. Thank you all so much 763 00:45:03,160 --> 00:45:05,600 Speaker 1: for joining me again this week. I look forward to 764 00:45:05,640 --> 00:45:09,480 Speaker 1: continuing this conversation with you all real soon. Take good care.