The Y in Psychiatry

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Cobenfy doesn't block dopamine — and that's the whole point. In this special episode, we step away from the bipolar just a bit to unpack the first genuinely new mechanism in schizophrenia treatment in decades. We break down how Cobenfy pairs xanomeline (a brain-penetrant M1/M4 muscarinic agonist) with trospium (a peripheral blocker that curbs the side effects), trace its surprising betel-nut origins, and explain the why behind the how: quieting dopamine in the striatum for positive symptoms and boosting GABA in the prefrontal cortex for cognition — all without the D2 blockade that brings EPS, weight gain, and sedation.

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We're now tracing how dopamine and serotonin imbalances map onto psychomotor agitation, depression, and that “too much energy” feel of mania. We also stop by the basal ganglia–thalamus–sensorimotor loop, the ventrolateral and ventromedial prefrontal cortex, the amygdala, and the superior frontal gyrus to show how disrupted circuits drive impulsivity, hyperemotionality, and goal-directed behavior. Say that 10 times.

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In this episode of The Y in Psychiatry, Dr. Amayo, Dr. V (Handratta), and Dr. Nguyen go full-neuroscience mode to unpack the neurochemistry and brain circuitry behind bipolar disorder — from dopamine/serotonin tug-of-wars to the roles of the prefrontal cortex, amygdala, and motor pathways in mania vs depression. Expect plenty of brain maps, metaphorical circuit diagrams, and maybe a few “mind-blown” moments. Perfect listening for psych residents, med students, or anyone curious what’s really going on when moods don’t just swing… they revolutionize.

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All aboard the Bipolar Express to unpack one of the messiest puzzles in psych: why diagnosing Bipolar Disorder sometimes feels like trying to solve a Rubik’s cube — when there could also be ADHD, anxiety, personality disorders, substance use, sleep-issues, or even childhood trauma riding shotgun. 

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We make a tokyo drift to a new topic: bipolarism! Lets jump in and manically (responsibly) get through as much as we can with depression and its interfaces. 

Hope you brought your shovel cause we're about to DIGFAST.

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It never gets old to talk about late-life depression. Lets explore why growing older can sometimes mean growing sadder.

We prance through executive dysfunction, vascular woes, inflammatory fires, and amyloid beta blues. 

We’ll discuss why SSRIs might not be the golden ticket and what alternatives, like dopamine agonists, rTMS, and even ECT, can brighten those grey years.

Plus, we'll ponder if your patient is depressed, or if their brain is just throwing a vascular tantrum.

Tune in, turn up your hearing aids, and fluid restrict for the next 20 minutes if you have the worlds smallest bladder.

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Lets do the discussion tango between the liver and psychotrops: today we're focusing on patients with cirrhosis. Discussing 1st-pass metabolism, phase 1 and 2 metabolisms, plasma protein binding, fluid overload, and the implications of these processes on medication efficacy and toxicity.

We know you liver this stuff.

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Lets explore the kidneys in psychiatry and discuss the impact of renal disease on medication management. No kidding these kidneys can be curiously be essential to know about for psychiatry.

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Explore the intersection of depression and neurocognitive disorders in elderly patients. The discussion highlights the challenges in differentiating between depression and apathy, the importance of accurate diagnosis, and the appropriate pharmacological considerations for treatment. 

Don't forget to listen to this episode on your geriatrics rotation.

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A continuation of Part one of potentially potent side effects of SSRIs - we now dive into the dark yet enlightening side effects of conventional antidepressants. From weight gain to sexual side effects and hyponatremia.

Please dose this episode PRN throughout your career.

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