This Is Your Brain On Drugs Psychiatry Podcast

Today we finally reach the GLP-1 medications! It's been a long slog through obesity medication, but I feel like this is what everyone has been waiting for. I will start off today by telling you how these medications work on the many parts of the body on which they do work. I will then go through the long list of benefits that they have on these various body systems, and I will back it up with the scientific literature. The benefits are massive and probably even more than you imagined, so have a listen! And don't worry I'll talk about all the stuff you need to be careful about on the next couple episodes, so it's not always rosy as with anything.

Today we will finish up on medications used for weight loss prior to going in to the GLP-1 medications. I will be discussing several medications today. These are medications that you will use less often, but most of them have important roles to play with some patients, so it's important to have them in your arsenal to personalize care. I'll discuss metformin (Glucophage), topiramate (Topamax), orlistat (Xenical), pramlintide (Symlin), Lorcaserin (Belviq), Gelesis100 (Plenity), Setmelanotide (Imcivree), and SGLT2 inhibitors.

Today is the last episode on ADHD, and I will finish off by talking about the effects of estrogen on ADHD symptoms both during the menstrual cycle and perimenopause. I will discuss using hormone replacement therapy as well as changes to ADHD medications to combat these symptoms. I will also discuss comorbid autism, anxiety, depression, and bipolar disorder as well as treating executive functioning which does not respond well to medication.

Today I will continue with weight loss medications, and we will focus on two of the newer options. First the phentermine/topiramate ER combination pill known as Qsymia. Then I will talk about the naltrexone/bupropion combination pill known as Contrave. You may be thinking to yourself, why even bother with these now that GLP1 medications are so effective and everyone is using them? Well, these medications definitely have their place and they are not as straightforward as you may think they are. There is a lot of nuance that you can use in prescribing them, and there are a number of things that you want to be careful about as well. These can be great for those where GLP1s are not an option, for those that have comorbid conditions in which these medications also treat, and also they are often needed prior to GLP1s if you are trying to get insurance to cover the GLP1, so definitely do not miss this one!

Today we will finish up the medications for ADHD with the remaining non-stimulant medications. There are actually quite a few non-stimulants with more than half being used off label. I will talk about the alpha 2 agonist medications guanfacine and clonidine, which are the FDA approved medications. Then, I will talk about off label options like TCAs and bupropion. Lastly, I will discuss two new medications on the horizon likely to be approved soon, solriamfetol and centanafadine. I will finish with saffron, which is one of the few herbal options which shows some promise.

We have finally finished going over lifestyle factors for obesity and mental health and will start talking about medications. Today I start with medications that you should be considering first line, including phentermine and several others that you are probably less familiar with like diethylpropion, phendimetrazine, and benzphetamine. I will talk about the amphetamines that have been used for weight loss as well as ones like Vyvanse that are currently used. I will also talk about fenfluramine and its connection to phentermine and also sibutrimine which was taken off the market. A lot of interesting history and pharmacology in here as well as details on how to use some of the most important medications for obesity!

Today we will be moving from the stimulant medications to the so called non-stimulants. Stimulants include methylphenidate and amphetamine as well as modafinil. There are actually quite a few non-stimulants with more than half being used off label. I will introduce the non-stimulants today and then talk in depth about two of them, atomoxetine, brand name Strattera, and one of the newest psychiatrist medications, viloxazine, brand name Qelbree.

We have finally finished going over lifestyle factors for obesity and mental health, and now if that was not enough to help the patient for weight loss and metabolic factors, we will need to consider using medications, but before we start medications, we need to do a medical assessment. Actually you would do this assessment before lifestyle factors, but I think this is a good time to talk about it right before we talk about obesity medications in the next podcast, so it may not be as exciting of a topic, but we have to screen patients for other causes of obesity as well as factors that will help us know what medication to select because there are contraindications to all medications as well as times when we can kill two birds with one stone, so you definitely should not breeze over this topic!

Today I will be wrapping up the lifestyle factors that contribute to health problems like mental health and obesity. I will briefly discuss getting adequate sleep, avoiding toxins like alcohol, tobacco, and drugs, healthy relationships, lifelong learning, and spending time outdoors. I think many of these are overlooked when trying to lose weight or fix mental health problems. Diet and exercise are all over the internet now, but I think these factors are neglected and ignored and doing so may just be the reason why things are getting better, so in that regard, these could actually be the most important factors. In fact having healthy relationships and socialization is probably the most important lifestyle factor to good health!

Today I will wrap up the last episode on adverse effects of stimulant medications used to treat ADHD. I will be discussing the black box warning regarding abuse, misuse, and addiction. This risk is very much overstated, and it leads to providers withholding potentially life changing medication from a lot of patients, so today I will be going over the scientific research on how risky these medications are, when to worry about it, and what to do when actual concern exists, so you won't want to miss this one!