spread the word, every little bit counts. I appreciate the support

@@ShrinksInSneakers I'm a PMHNP. I tell colleagues about you all the time.

Unresolved, generational trauma is more than likely "the cause".

I agree more focus should be placed on supervised work environments, social skills training, and other interventions to address the problems of life many people with serious mental illness face. This is more of a Societal issue where I as a physician addressing the symptoms of mental illness do not see the necessary investment of money and resources into programs like those mentioned above. Until we start valuing these interventions we are unlikely to see much change in a practical sense

It's out today 😁

@@ShrinksInSneakers Thanks. I'm watching it now. Do you care to comment on adding Dexedrine to California rocket fuel to boost dopamine? My mental health care NP is letting me try it after adding Wellbutrin to do the same thing didn't work well at all. The Wellbutrin made me a bit crabby, like I was before I started taking the mirtazapine-venlafaxine combination. The Dex seems to be helping both with depression and motivation. Is Dex used much for depression, anxiety, etc.? Thanks for the new video, too!

@@t2000kw I have not used all these medications in combination and I'm not aware of a strong evidence base in the literature for it. There are cases where a stimulant can be added to an antidepressant treatment regimen, but that usually comes after a lot of other stuff has been tried.

Thank you for being a part of the community, my thinking is always evolving and many of these things discussed here are related to my direct interaction and treatment of real life patients. This is what I see and I want to share it. Hope it helped

A costly venture

Personalization of treatment is very important and many people do not meet the criteria of any one specific DSM diagnosis yet still have symptoms and need help. We have to determine thing like how bipolar is the person sitting across from me and make treatment decisions based on the diagnosis that is most fitting

This is an atypical antidepressant that stimulates melatonin receptors and blocks some serotonin receptors to improve mood and anxiety symptoms. I do not use it in my practice, but I did read the Coharane review on it which found it to be no more effective than other antidepressants. It did however have a lower risk of sexual side effects which is very important. Hope this helps

Thank you very much, doctor! I'm from Brazil and your teachings have been of great value. All my treatment has been based on the information in your videos, I take them to my psychiatrist and we discuss the best option. God bless you!

High levels of anxiety and depressive symptoms that are moderate fall into the neurotic depression category. The difficult part is answering the question is the depression causing the anxiety. In my opinion you need to have a higher archery of diagnosis. I would start with treating depression to remission and then seeing if the anxiety persists. With OCD the same situation can be applied treat the OCD to remission and see if the depressive symptoms resolve. Many of the OCD medication treatments are the same as depression treatments so there will be a lot of overlap. The type of psychotherapy will be different in the case of OCD exposure and response prevention. Hope this helps

@@ShrinksInSneakers Thanks for your thought out reply..Ive been diagnosed with OCD and various depression labels...Reccurent/Mixed etc I think i probably fall on the neurotic depression although i have been tipped into major depression in the past..My last "Severe" episode was some years back and was very "Mixed"lack of sleep,Early waking,no appitite,agitated,angry suicidal etc but also i developed almost delusional /paranoid ideas...Ive been perscribed anti psychotic treatment in the past but always worried over side effects..I,m currently on antidepressants(10 years) and find i still have Symptoms (OCD ones mainly) Does what i described above respond well to antipsychotics ?? Thanks Again

For OCD with derealization I recommend TCA or TeCA antidepressants. OCD alone can go away by itself