Back from the Abyss: Psychiatry in Stories | Psychotherapy, Trauma, and Psychedelics

Antidepressants, mood stabilizers, antipsychotics, benzodiazepines, stimulants.....READY SET GO!

Med cheat sheet
SSRIs (selective serotonin reuptake inhibitors)-- Prozac, Lexapro, Paxil, Celexa, Zoloft, Luvox, Trintellix, Viibryd-- They are generally NOT antidepressants

Mainly helpful for OCD, body dysmorphia,  panic (if not from trauma), depression if postpartum or fueled by neuroticism or ruminative anxiety


SNRIs (serotonin norepinephrine reuptake inhibitors)-- Effexor/venlafaxine, Cymbalta/duloxetine

Mostly helpful for combined depression/anxiety, especially with insomnia


Wellbutrin/bupropion-- very stimulating (prison crack!), true antidepressant; can trigger/worsen anxiety


MAO  (monoamine oxidase) inhibitors-- powerful antidepressants, lots of side effects and med interactions


Lamictal/lamotrigine-- definitely ALL THAT and a bag of chips (see My Desert Island Meds in Season 1)


Atypical antipsychotics-  Abilify/aripiprazole, Latuda/lurasidone, Seroquel/quetiapine, Saphris/asenapine, Vraylar/cariprazine, Risperdal/risperidone, Zyprexa/olanzapine, Geodon/ziprasidone, Invega/paliperidone

Generally good mood stabilizers (in contrast to the putative "mood stabilizers" below); typically more helpful for severe depression and bipolar disorder than true psychosis (Zyprexa and Risperdal excepted)


"Mood stabilizers"- (big misnomer, most effective for  mania/agitation, not depression)-- Depakote/valproic acid, Trileptal/oxcarbazepine, Tegretol/carbamazepine


Lithium- it's not clozapine, but gets the silver medal as a true mood stabilizer (see My Desert Island Meds in Season 1)


Clozapine- the winner of the psychiatric med decathlon in most every event; needs weekly blood monitoring and has a few very serious potential side effects


Benzodiazepines- Xanax/alprazolam; Klonopin/clonazepam, Librium/chlordiazepoxide, Ativan/lorazepam, Valium/diazepam


Stimulants- Adderall/amphetamine; Vyvanse; Ritalin/Concerta/Focalin/methylphenidate

Amphetamines are more euphoria-inducing, thus more abused and addictive and also tend to have more side effects; both amphetamines and methylphenidate are roughly equally effective for ADD/ADHD


BFTA
https://www.craigheacockmd.com/podcast-page/

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How do you show up for others when you are facing the loss of everything you have ever known and loved?

Here Leah Barrett, a Colorado-based psychotherapist, opens her heart and shares her story of managing the careful dance of witnessing her clients' pain and trauma while she faces her own unfolding medical nightmare.  Leah and Craig explore this immediacy and the implications for doing the sacred work of psychotherapy.

Leah Barrett's podcast --Precarious
https://www.leahbarrett.com/precarious-podcast

BFTA
https://www.craigheacockmd.com/podcast-page/

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What's the special sauce of psychological and psychiatric treatment? How do we change, particularly in relationship with others?  Here Dr. Hillary McBride, a psychotherapist, researcher, author, and podcast host (Other People's Problems) opens up about the details of her years of psychiatric treatment, what worked (often surprising!), what did not, and how she had to leave home to find a home in herself.

Dr. Hillary McBride
https://hillarylmcbride.com

Hillary's new book-- The Wisdom of Your Body
https://www.amazon.com/Wisdom-Your-Body-Wholeness-Connection/dp/1587435527/ref=sr_1_2?dchild=1&keywords=hillary+mcbride&qid=1617029987&sr=8-2

BFTA
https://www.craigheacockmd.com

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How can we stop the heartbreaking and horrific spiral of addiction?

Dr. Jeremy Dubin, the Medical Director of Colorado's Front Range Clinic, sits down with Dr. H to discuss their top five things that actually work....and the five factors which most predict jails, institutions, and death.

Dr. H and BFTA
https://www.craigheacockmd.com

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BFTA takes a wild ride with Colorado based artist, writer, and video producer Ian Jaydid as he tells his double abyss story of lucid dreaming, out of body experiences, REM deprivation and transient psychosis....which then led to the blissful but ultimately destructive salve of opioids and a life changing encounter with the African psychedelic Iboga (ibogaine).

Ian Jaydid
https://ianjaydid.com

Ian's novel Tripping the Field
https://www.amazon.com/Tripping-Field-Existential-Ungodly-Proportions/dp/0991193199

Ian's first lucid dreaming experience
https://www.youtube.com/watch?v=j-WaA3SGl9M&t=26s

Dr. H/ BFTA
https://www.craigheacockmd.com/podcast-page/

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In the context of an increasingly severe shortage of psychiatrists,  Dr. H discusses some uncomfortable truths about why finding a good outpatient psychiatrist is even more difficult than ever.

Psychedelics and Psychiatry-- Dr. H on The Third Wave Podcast
https://thethirdwave.co/podcast/episode-112-craig-heacock/

BFTA and Dr. H
https://www.craigheacockmd.com

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The therapeutic relationship is built on trust, we come to therapy expecting that we are going to be heard and believed.

Jeanine wasn't believed-- about her childhood sexual assaults, or the emerging psychotic symptoms, or her intractable suicidality....even after many near fatal attempts and over 40 inpatient stays.

This episode looks at how and why we believe some people and discount others.  It turns out that the way people tell us their stories matters just as much as the actual words they choose. And, unfortunately, certain clinical presentations make patients/clients much less likely to be heard and believed.

A heads up-- this episode includes descriptions of childhood sexual abuse, self-harm, and suicide attempts.


Dopamine, saliency, and the onset of paranoia
https://www.nature.com/articles/s41398-020-00912-4

Borderline personality diagnosis leads to demedicalization and poor treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870819/

Inappropriate affect
https://www.betterhelp.com/advice/personality-disorders/inappropriate-affect-symptoms-and-signs/

Dr. H/BFTA
https://www.craigheacockmd.com

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Some things in life defy explanation...like tripping on mushrooms and arresting the plunge into alcoholism.

Here Stella shares her story of childhood abuse and neglect, her reenactment of the abuse through toxic relationships with men, and then her life-changing sessions with both psilocybin and MDMA. Stella and Dr. H explore how she was able to first bring her dissociated and numbed self back to life with the help of psilocybin and later heal her attachment wounds and trauma with MDMA-assisted psychotherapy.

BFTA and Dr. H
http://craigheacockmd.com

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Dr. H sits down with Dr. David Puder, a psychiatrist and host of the Psychiatry and Psychotherapy podcast, to explore the beauty and challenge and mystery of psychotherapy. 

What are Chris and Craig wanting for Christmas...??? How about writing us a review!

Dr. Puder and the Psychiatry and Psychotherapy podcast
https://www.psychiatrypodcast.com

Dr. H essay on psychedelic healing for CNN.com
https://www.cnn.com/2020/12/20/opinions/psychedelics-trauma-healing-this-is-life-heacock/index.html

BFTA and Dr. H
https://www.craigheacockmd.com

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In most specialties of medicine, the dictum "Diagnosis guides treatment" is the law of the land. In psychiatry, however, most of what we treat are often overlapping syndromes, not actual diseases, and these syndromes involve hugely varying dimensions of symptoms with a vast array of potential causes and exacerbating factors.

Maggie came to Dr. H with a challenging clinical presentation:  likely genetic loading for a mood and/or anxiety disorder, childhood emotional neglect, years of school problems, hormone irregularities and progesterone hypersensitivity, all leading to  steadily worsening mood instability, depression, and hopelessness.  Over the course of the last 12 years, Maggie and Dr. H were eventually able to co-create both a successful treatment course and a shame-free narrative, without a clear diagnosis to guide them.

Comments, suggestions, questions? We'd love to hear them! Email us via https://www.craigheacockmd.com or message us on Twitter @bftapod

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