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Transcript

The Dance Between Dependence, Depression, and Dopamine: A Case Study of Beanbag Benny · Pearls and Prep

• 0:03
  Welcome
• 0:04
  back
• 0:04
  to
• 0:04
  Pearls
• 0:05
  and
• 0:05
  Prep
• 0:06
  your
• 0:06
  go-to
• 0:06
  spot
• 0:07
  for
• 0:07
  pearls
• 0:08
  that
• 0:08
  prep
• 0:08
  you
• 0:09
  to
• 0:09
  practice.
• 0:10
  today
• 0:11
  we
• 0:11
  have
• 0:11
  a
• 0:11
  very
• 0:12
  interesting
• 0:13
  case.
• 0:14
  Our
• 0:15
  friend
• 0:15
  Bean
• 0:16
  bag,
• 0:17
  Benny.
• 0:18
  This
• 0:18
  is
• 0:18
  a
• 0:18
  34-year-old.
• 0:20
  White
• 0:21
  male.
• 0:21
  He's
• 0:21
  fake.
• 0:22
  Now,
• 0:22
  again,
• 0:23
  I
• 0:23
  don't
• 0:23
  mean
• 0:23
  his
• 0:23
  personality's
• 0:24
  fake.
• 0:25
  I
• 0:25
  don't
• 0:25
  mean
• 0:25
  he's
• 0:25
  a
• 0:25
  fake
• 0:26
  person,
• 0:26
  as
• 0:27
  in
• 0:27
  you
• 0:27
  wouldn't
• 0:27
  like
• 0:28
  him.
• 0:28
  What
• 0:29
  I
• 0:29
  mean
• 0:29
  is
• 0:29
  that
• 0:29
  this
• 0:29
  is
• 0:29
  a
• 0:30
  mock
• 0:30
  patient,
• 0:31
  okay?
• 0:31
  And
• 0:32
  I
• 0:32
  do
• 0:32
  that
• 0:32
  to
• 0:32
  protect
• 0:33
  patient
• 0:33
  privacy.
• 0:34
  This
• 0:34
  is
• 0:34
  a
• 0:34
  mock
• 0:35
  patient
• 0:35
  that
• 0:36
  you
• 0:36
  may
• 0:36
  see
• 0:36
  in
• 0:37
  your
• 0:37
  practice
• 0:37
  in
• 0:38
  the
• 0:38
  future.
• 0:39
  And
• 0:39
  I'll
• 0:39
  tell
• 0:39
  you
• 0:40
  folks,
• 0:40
  as
• 0:40
  a
• 0:41
  psychiatric
• 0:42
  np,
• 0:43
  it's
• 0:44
  very
• 0:45
  challenging
• 0:46
  to
• 0:46
  treat
• 0:46
  patients
• 0:47
  who
• 0:47
  use
• 0:47
  cannabis.
• 0:48
  So
• 0:49
  this.
• 0:50
  Presentation
• 0:51
  or
• 0:51
  chat
• 0:52
  Today
• 0:52
  is
• 0:52
  gonna
• 0:52
  be
• 0:53
  about
• 0:54
  weed
• 0:54
  and
• 0:55
  Wellbutrin,
• 0:55
  as
• 0:56
  I
• 0:56
  call
• 0:56
  it,
• 0:56
  the
• 0:56
  dance
• 0:57
  between
• 0:57
  dependence,
• 0:58
  depression,
• 0:58
  and
• 0:58
  dopamine.
• 0:59
  Now,
• 0:59
  beanbag
• 1:00
  Benny
• 1:01
  is
• 1:01
  a
• 1:01
  34-year-old
• 1:02
  white
• 1:03
  male.
• 1:04
  His
• 1:04
  first
• 1:04
  depressive
• 1:05
  episode
• 1:05
  was
• 1:05
  around
• 1:06
  the
• 1:06
  age
• 1:06
  of
• 1:06
  15
• 1:07
  years
• 1:07
  old.
• 1:08
  He's
• 1:08
  had
• 1:08
  a
• 1:08
  recurrence
• 1:09
  at
• 1:10
  age
• 1:10
  27
• 1:11
  after
• 1:11
  a
• 1:11
  breakup,
• 1:12
  and
• 1:12
  some
• 1:12
  job
• 1:12
  burnout.
• 1:13
  No
• 1:13
  history
• 1:14
  of
• 1:14
  mania,
• 1:14
  hypomania,
• 1:15
  psychosis,
• 1:16
  or
• 1:16
  suicide
• 1:17
  attempts.
• 1:17
  He
• 1:18
  has
• 1:18
  tried
• 1:18
  Prozac
• 1:19
  in
• 1:19
  the
• 1:19
  past,
• 1:19
  but
• 1:20
  he
• 1:20
  said
• 1:20
  it
• 1:20
  was
• 1:20
  quite
• 1:21
  numbing
• 1:22
  emotionally,
• 1:22
  and
• 1:22
  he
• 1:22
  had.
• 1:23
  Bedroom
• 1:23
  side
• 1:24
  effects
• 1:24
  He's
• 1:24
  never
• 1:25
  been
• 1:25
  hospitalized
• 1:26
  psychiatrically,
• 1:27
  and
• 1:27
  he's
• 1:27
  coming
• 1:27
  to
• 1:27
  you
• 1:27
  in
• 1:28
  the
• 1:28
  outpatient
• 1:28
  space
• 1:29
  saying,
• 1:29
  geez,
• 1:30
  I
• 1:30
  just
• 1:30
  feel
• 1:30
  like
• 1:30
  I
• 1:30
  can't
• 1:31
  get
• 1:31
  outta
• 1:31
  my
• 1:31
  own
• 1:31
  way.
• 1:32
  I
• 1:32
  have
• 1:32
  no
• 1:32
  energy.
• 1:33
  I'm
• 1:33
  always
• 1:34
  tired.
• 1:35
  My
• 1:35
  smoking
• 1:35
  is
• 1:35
  out
• 1:36
  of
• 1:36
  control.
• 1:36
  I'm
• 1:36
  snacking
• 1:37
  all
• 1:37
  the
• 1:37
  time.
• 1:38
  he's
• 1:38
  not
• 1:38
  suicidal.
• 1:39
  He
• 1:39
  just
• 1:39
  says
• 1:39
  he's
• 1:39
  permanently
• 1:40
  meh.
• 1:41
  he
• 1:41
  had
• 1:41
  a
• 1:42
  routine
• 1:42
  physical
• 1:42
  with
• 1:43
  his
• 1:43
  PCP
• 1:44
  and
• 1:44
  he
• 1:45
  states
• 1:45
  that
• 1:45
  it
• 1:45
  was
• 1:46
  otherwise
• 1:46
  unremarkable.
• 1:48
  He
• 1:48
  does
• 1:48
  have
• 1:48
  some
• 1:48
  asthma.
• 1:50
  History
• 1:50
  of
• 1:50
  seizures
• 1:50
  trauma
• 1:51
  or
• 1:51
  kidney,
• 1:52
  liver
• 1:52
  disease.
• 1:52
  he
• 1:53
  also
• 1:53
  share
• 1:53
  with
• 1:53
  you,
• 1:54
  he
• 1:54
  has
• 1:54
  a
• 1:54
  mom
• 1:54
  with
• 1:55
  generalized
• 1:55
  anxiety
• 1:56
  disorder.
• 1:57
  He.
• 1:58
  Says
• 1:58
  Mom
• 1:58
  treated
• 1:59
  that
• 1:59
  anxiety
• 1:59
  with
• 2:00
  podcasts
• 2:01
  and
• 2:01
  wine.
• 2:02
  Dad
• 2:03
  probably
• 2:03
  had
• 2:03
  depression.
• 2:04
  Dad
• 2:04
  was
• 2:04
  down
• 2:05
  a
• 2:05
  lot
• 2:05
  under
• 2:05
  the
• 2:05
  covers
• 2:06
  kind
• 2:06
  of
• 2:06
  morose
• 2:08
  and
• 2:08
  drank
• 2:08
  a
• 2:08
  little
• 2:08
  more
• 2:09
  than
• 2:09
  he
• 2:09
  should
• 2:09
  have
• 2:10
  beanbag
• 2:10
  Benny
• 2:11
  is
• 2:11
  a
• 2:11
  social
• 2:11
  drinker.
• 2:12
  and
• 2:12
  he
• 2:13
  occasionally
• 2:13
  uses
• 2:14
  cannabis.
• 2:15
  He
• 2:15
  denies
• 2:15
  any
• 2:16
  cigarette
• 2:16
  use.
• 2:17
  he
• 2:17
  is
• 2:17
  not
• 2:18
  on
• 2:18
  any
• 2:18
  medications.
• 2:18
  he's
• 2:19
  coming
• 2:19
  back
• 2:19
  to
• 2:19
  you
• 2:19
  today
• 2:20
  because
• 2:20
  he
• 2:20
  feels
• 2:21
  emotionally
• 2:22
  heavy.
• 2:23
  He's
• 2:23
  fatigued.
• 2:24
  His
• 2:24
  motivation
• 2:25
  is
• 2:25
  in
• 2:26
  the
• 2:26
  dumps.
• 2:26
  He
• 2:27
  craves
• 2:27
  carbs
• 2:28
  all
• 2:28
  the
• 2:28
  time.
• 2:28
  He
• 2:28
  says
• 2:29
  he
• 2:29
  can
• 2:29
  eat
• 2:29
  an
• 2:29
  entire
• 2:29
  box
• 2:30
  of
• 2:30
  Lucky
• 2:30
  Charms,
• 2:31
  during
• 2:32
  Jeopardy.
• 2:32
  He
• 2:32
  sleeps
• 2:33
  too
• 2:33
  much.
• 2:34
  He
• 2:34
  used
• 2:34
  to
• 2:34
  love
• 2:34
  basketball.
• 2:35
  He
• 2:35
  is
• 2:35
  had
• 2:35
  crying
• 2:36
  spells
• 2:36
  on
• 2:36
  and
• 2:36
  off
• 2:37
  since
• 2:37
  the
• 2:37
  age
• 2:37
  of
• 2:37
  15.
• 2:38
  and
• 2:39
  that
• 2:39
  began
• 2:39
  a
• 2:39
  very
• 2:40
  long
• 2:40
  time
• 2:40
  ago.
• 2:41
  And
• 2:41
  he
• 2:41
  has
• 2:41
  a
• 2:41
  hard
• 2:42
  time
• 2:42
  concentrating.
• 2:42
  Now.
• 2:43
  what
• 2:43
  are
• 2:43
  some
• 2:43
  things
• 2:44
  that
• 2:44
  you
• 2:44
  think
• 2:45
  you
• 2:45
  need
• 2:45
  to
• 2:45
  ask
• 2:46
  beanbag?
• 2:47
  Benny?
• 2:47
  What,
• 2:47
  what
• 2:47
  do
• 2:47
  you
• 2:47
  wanna
• 2:48
  know
• 2:48
  about
• 2:48
  'em?
• 2:48
  See,
• 2:49
  this
• 2:49
  is
• 2:49
  important
• 2:49
  as
• 2:49
  a
• 2:49
  psych
• 2:50
  and
• 2:50
  p,
• 2:50
  you're
• 2:51
  gonna
• 2:51
  get
• 2:51
  This
• 2:52
  blob
• 2:52
  of
• 2:52
  information,
• 2:53
  if
• 2:53
  you
• 2:53
  will,
• 2:54
  and
• 2:54
  your
• 2:55
  goal
• 2:56
  when
• 2:56
  you're
• 2:56
  getting
• 2:56
  the
• 2:56
  information
• 2:57
  from
• 2:57
  your
• 2:57
  patient
• 2:58
  is
• 2:58
  to
• 2:58
  figure
• 2:59
  out
• 3:00
  what
• 3:00
  are
• 3:00
  the
• 3:00
  breadcrumbs
• 3:01
  that
• 3:01
  he's
• 3:01
  dropping?
• 3:02
  What
• 3:02
  are
• 3:03
  the
• 3:04
  things
• 3:04
  that
• 3:05
  deserve
• 3:05
  more
• 3:05
  attention?
• 3:06
  I
• 3:06
  always
• 3:06
  refer
• 3:07
  to
• 3:07
  these
• 3:07
  when
• 3:07
  I
• 3:07
  teach
• 3:08
  this
• 3:08
  as
• 3:09
  oranges
• 3:10
  to
• 3:10
  squeeze.
• 3:11
  I
• 3:11
  want
• 3:11
  you
• 3:11
  to
• 3:11
  conceptualize
• 3:12
  it
• 3:12
  like
• 3:12
  that,
• 3:13
  my
• 3:13
  friends,
• 3:14
  sometimes
• 3:14
  a
• 3:14
  patient's
• 3:15
  gonna
• 3:15
  throw
• 3:15
  you
• 3:16
  an
• 3:16
  orange,
• 3:17
  And
• 3:17
  it's
• 3:17
  gonna
• 3:17
  be
• 3:17
  loaded
• 3:18
  with
• 3:18
  potentially
• 3:19
  rich
• 3:20
  follow-up
• 3:21
  questions
• 3:21
  that
• 3:21
  you
• 3:22
  need
• 3:22
  to
• 3:22
  ask
• 3:22
  that
• 3:23
  would
• 3:23
  be
• 3:23
  super
• 3:24
  pertinent
• 3:25
  for
• 3:25
  your
• 3:25
  diagnosis,
• 3:26
  for
• 3:26
  your
• 3:26
  treatment,
• 3:27
  right?
• 3:28
  Because
• 3:28
  diagnosis
• 3:28
  comes
• 3:29
  first,
• 3:29
  then
• 3:29
  treatment.
• 3:30
  If
• 3:30
  you
• 3:30
  get
• 3:30
  a
• 3:30
  really
• 3:31
  accurate
• 3:31
  diagnosis
• 3:32
  or
• 3:32
  you
• 3:32
  think
• 3:32
  you
• 3:32
  get
• 3:32
  an
• 3:32
  accurate
• 3:33
  diagnosis,
• 3:34
  then
• 3:34
  your
• 3:34
  treatment's
• 3:35
  gonna
• 3:35
  follow.
• 3:35
  Your
• 3:36
  patient
• 3:36
  outcomes
• 3:36
  are
• 3:36
  gonna
• 3:37
  improve.
• 3:38
  Your
• 3:38
  job's
• 3:38
  gonna
• 3:38
  get
• 3:39
  easier.
• 3:39
  'cause
• 3:39
  every
• 3:39
  time
• 3:40
  they
• 3:40
  come
• 3:40
  back.
• 3:41
  You
• 3:41
  know,
• 3:41
  there's
• 3:41
  gonna
• 3:41
  be
• 3:42
  a
• 3:42
  little
• 3:42
  less
• 3:42
  to
• 3:42
  do
• 3:43
  'cause
• 3:43
  they're
• 3:44
  gonna
• 3:44
  be
• 3:44
  just
• 3:44
  more
• 3:44
  stable,
• 3:45
  right?
• 3:45
  And
• 3:45
  there's
• 3:46
  less
• 3:46
  management.
• 3:47
  So
• 3:47
  it's
• 3:47
  in
• 3:48
  your
• 3:48
  interest
• 3:48
  to
• 3:48
  treat
• 3:49
  every
• 3:49
  question
• 3:51
  you
• 3:51
  have
• 3:51
  for
• 3:51
  beanbag
• 3:52
  Benny
• 3:53
  to
• 3:53
  be
• 3:53
  high
• 3:53
  yield.
• 3:54
  And
• 3:54
  anything
• 3:55
  he
• 3:55
  answers
• 3:55
  ask
• 3:56
  yourself,
• 3:56
  did
• 3:56
  he
• 3:56
  just
• 3:56
  hand
• 3:57
  me
• 3:57
  an
• 3:57
  orange
• 3:57
  full
• 3:58
  of
• 3:58
  juice?
• 3:58
  And
• 3:58
  if
• 3:58
  so,
• 3:58
  squeeze
• 3:59
  it.
• 4:00
  Squeeze
• 4:00
  all
• 4:01
  the
• 4:01
  orange
• 4:01
  out
• 4:01
  of
• 4:02
  that
• 4:02
  juice
• 4:02
  now.
• 4:03
  When
• 4:04
  beanbag
• 4:05
  Benny
• 4:05
  is
• 4:06
  telling
• 4:06
  you
• 4:07
  that
• 4:08
  he
• 4:08
  feels,
• 4:10
  really
• 4:10
  down
• 4:11
  and
• 4:11
  fatigued,
• 4:12
  that's
• 4:13
  an
• 4:13
  orange
• 4:14
  with
• 4:14
  a
• 4:14
  lot
• 4:14
  of
• 4:14
  juice
• 4:14
  in
• 4:15
  it,
• 4:15
  Because
• 4:15
  that
• 4:15
  could
• 4:15
  be
• 4:15
  so
• 4:16
  many
• 4:16
  different
• 4:16
  things.
• 4:16
  Of
• 4:16
  course,
• 4:17
  you're
• 4:17
  thinking
• 4:17
  depression,
• 4:18
  you
• 4:18
  might
• 4:18
  be
• 4:18
  thinking
• 4:19
  in
• 4:19
  the
• 4:19
  back
• 4:19
  of
• 4:19
  your
• 4:19
  mind,
• 4:20
  is
• 4:20
  this
• 4:20
  a
• 4:20
  thyroid
• 4:21
  issue?
• 4:21
  if
• 4:21
  you're
• 4:22
  tired
• 4:22
  all
• 4:22
  the
• 4:22
  time,
• 4:23
  if
• 4:23
  you're
• 4:23
  down,
• 4:24
  he's
• 4:24
  also
• 4:24
  telling
• 4:25
  you
• 4:25
  he
• 4:25
  craves
• 4:25
  carbs.
• 4:26
  That's,
• 4:27
  and
• 4:27
  he's
• 4:27
  also
• 4:27
  telling
• 4:28
  you
• 4:28
  he
• 4:28
  uses
• 4:28
  cannabis
• 4:29
  and
• 4:29
  he
• 4:29
  says
• 4:30
  occasional
• 4:30
  cannabis.
• 4:31
  That's
• 4:31
  an
• 4:31
  orange
• 4:32
  full
• 4:33
  of
• 4:33
  juice.
• 4:33
  There's
• 4:33
  so
• 4:34
  much
• 4:34
  squeezing
• 4:34
  left
• 4:35
  in
• 4:35
  that
• 4:36
  orange.
• 4:36
  Don't
• 4:36
  let
• 4:36
  him
• 4:37
  off
• 4:37
  the
• 4:37
  hook
• 4:37
  there.
• 4:37
  Be
• 4:37
  compassionate,
• 4:38
  be
• 4:38
  warm,
• 4:39
  be
• 4:40
  ready.
• 4:40
  But
• 4:40
  you
• 4:41
  want
• 4:41
  him
• 4:41
  to
• 4:41
  quantify,
• 4:42
  you
• 4:42
  know,
• 4:43
  how
• 4:43
  often
• 4:43
  are
• 4:43
  you
• 4:43
  using
• 4:44
  cannabis?
• 4:45
  You
• 4:45
  know,
• 4:46
  what
• 4:46
  does
• 4:46
  your
• 4:46
  relationship
• 4:47
  with
• 4:47
  cannabis
• 4:47
  look
• 4:48
  like?
• 4:48
  What
• 4:49
  are
• 4:49
  some
• 4:49
  reasons
• 4:50
  that
• 4:50
  you
• 4:50
  use
• 4:51
  cannabis?
• 4:51
  Now,
• 4:51
  you
• 4:51
  don't
• 4:52
  wanna
• 4:52
  ask
• 4:52
  that
• 4:52
  judgmentally,
• 4:53
  of
• 4:53
  course.
• 4:54
  that's
• 4:54
  not
• 4:55
  why.
• 4:55
  why
• 4:55
  he's
• 4:55
  coming
• 4:56
  to
• 4:56
  see
• 4:56
  you
• 4:56
  to
• 4:56
  be
• 4:56
  judged.
• 4:57
  He's
• 4:57
  coming
• 4:58
  for
• 4:58
  relief.
• 4:58
  compassion.
• 4:59
  and
• 5:00
  insight
• 5:00
  into
• 5:00
  what's
• 5:01
  holding
• 5:01
  him
• 5:01
  back,
• 5:02
  because
• 5:02
  he's
• 5:02
  clearly
• 5:03
  telling
• 5:03
  you
• 5:03
  I
• 5:03
  can't
• 5:04
  get
• 5:04
  out
• 5:04
  of
• 5:04
  my
• 5:04
  own
• 5:04
  way.
• 5:05
  I
• 5:05
  have
• 5:05
  no
• 5:05
  energy.
• 5:06
  I'm
• 5:06
  always
• 5:06
  tired.
• 5:08
  So.
• 5:09
  Your
• 5:09
  goal
• 5:09
  is
• 5:10
  to
• 5:10
  figure
• 5:11
  out
• 5:11
  what
• 5:11
  is
• 5:11
  in
• 5:11
  his
• 5:11
  way.
• 5:12
  occasional
• 5:12
  cannabis
• 5:13
  use,
• 5:14
  your
• 5:14
  patients
• 5:14
  are
• 5:14
  often
• 5:15
  gonna
• 5:15
  just
• 5:15
  tell
• 5:16
  you
• 5:16
  things.
• 5:16
  They
• 5:16
  know
• 5:17
  their
• 5:17
  own
• 5:17
  situation
• 5:18
  better
• 5:18
  than
• 5:18
  you
• 5:18
  ever
• 5:19
  could,
• 5:19
  and
• 5:19
  so
• 5:19
  they
• 5:20
  are
• 5:20
  experts
• 5:20
  in
• 5:21
  their
• 5:21
  own
• 5:21
  lives,
• 5:22
  but
• 5:22
  they're
• 5:22
  gonna
• 5:23
  give
• 5:23
  you
• 5:23
  verbiage
• 5:24
  that
• 5:24
  deserves
• 5:25
  fine
• 5:26
  tuning
• 5:26
  and
• 5:27
  questioning
• 5:27
  occasional
• 5:28
  cannabis
• 5:28
  use
• 5:29
  is
• 5:29
  just
• 5:29
  such
• 5:30
  verbiage
• 5:30
  where
• 5:30
  we
• 5:31
  really
• 5:31
  need
• 5:31
  him
• 5:31
  to
• 5:31
  break
• 5:32
  it
• 5:32
  down.
• 5:33
  how
• 5:33
  often.
• 5:34
  do
• 5:34
  you
• 5:34
  use
• 5:34
  it?
• 5:35
  What's
• 5:35
  the
• 5:36
  potency
• 5:37
  of
• 5:37
  your
• 5:37
  cannabis
• 5:38
  with
• 5:38
  respect
• 5:38
  to
• 5:38
  THC?
• 5:39
  Now,
• 5:39
  in
• 5:39
  my
• 5:39
  experience,
• 5:40
  a
• 5:40
  lot
• 5:40
  of
• 5:40
  patients
• 5:41
  don't
• 5:41
  know.
• 5:41
  They
• 5:41
  just
• 5:42
  smoke
• 5:42
  cannabis.
• 5:43
  find
• 5:43
  whatever
• 5:43
  is
• 5:43
  on
• 5:44
  the
• 5:44
  market.
• 5:45
  And
• 5:45
  use
• 5:45
  it,
• 5:46
  they
• 5:46
  don't
• 5:46
  always
• 5:46
  know
• 5:47
  that,
• 5:47
  in
• 5:47
  the
• 5:47
  1970s,
• 5:48
  cannabis
• 5:49
  averaged
• 5:49
  around
• 5:49
  3%
• 5:51
  in
• 5:51
  terms
• 5:51
  of
• 5:51
  THC
• 5:52
  content
• 5:52
  and
• 5:52
  today's
• 5:53
  concentrates
• 5:53
  can
• 5:53
  exceed
• 5:54
  80%
• 5:54
  or
• 5:54
  higher.
• 5:55
  It's
• 5:55
  a
• 5:55
  completely
• 5:56
  different
• 5:56
  pharmacological
• 5:57
  exposure
• 5:58
  nowadays.
• 5:59
  these
• 6:00
  are
• 6:00
  uncharted
• 6:01
  waters.
• 6:01
  This
• 6:01
  is
• 6:02
  a
• 6:02
  different
• 6:03
  kind
• 6:03
  of
• 6:03
  landscape.
• 6:06
  A
• 6:06
  lot
• 6:06
  of
• 6:06
  states
• 6:07
  have
• 6:07
  legalized
• 6:07
  this,
• 6:08
  right?
• 6:08
  So
• 6:08
  you
• 6:08
  have
• 6:08
  a
• 6:08
  lot
• 6:08
  of
• 6:09
  patients
• 6:09
  who
• 6:09
  feel
• 6:10
  this
• 6:10
  is
• 6:10
  no
• 6:11
  big
• 6:11
  deal,
• 6:11
  it's
• 6:11
  legal.
• 6:12
  It
• 6:12
  must
• 6:12
  not
• 6:12
  be
• 6:12
  too
• 6:13
  bad.
• 6:13
  Maybe
• 6:13
  they
• 6:13
  know
• 6:14
  it's
• 6:14
  not
• 6:14
  great,
• 6:14
  but
• 6:14
  they
• 6:14
  also
• 6:15
  realize
• 6:15
  it
• 6:16
  must
• 6:16
  not
• 6:16
  be
• 6:16
  too
• 6:16
  bad.
• 6:17
  So
• 6:17
  they
• 6:17
  have
• 6:17
  all
• 6:17
  these
• 6:18
  preconceptions
• 6:19
  about
• 6:19
  their
• 6:20
  use.
• 6:20
  Now
• 6:21
  you
• 6:21
  have
• 6:22
  two
• 6:22
  juicy
• 6:22
  oranges
• 6:23
  in
• 6:23
  front
• 6:23
  of
• 6:23
  you,
• 6:24
  right?
• 6:24
  You
• 6:24
  have
• 6:25
  his
• 6:25
  cannabis
• 6:25
  use
• 6:26
  and
• 6:26
  you
• 6:26
  have
• 6:26
  what
• 6:26
  looked
• 6:27
  like
• 6:27
  clearly
• 6:28
  depressive
• 6:29
  symptoms.
• 6:29
  He
• 6:29
  did
• 6:29
  tell
• 6:30
  you
• 6:30
  he
• 6:30
  went
• 6:30
  to
• 6:30
  his
• 6:30
  PCP,
• 6:31
  his
• 6:31
  primary
• 6:31
  care
• 6:32
  provider,
• 6:32
  and
• 6:33
  his.
• 6:34
  Labs
• 6:34
  were
• 6:34
  ruled
• 6:35
  as
• 6:35
  normal.
• 6:35
  So
• 6:36
  assuming
• 6:36
  we
• 6:36
  have
• 6:37
  normal
• 6:37
  labs
• 6:37
  on
• 6:37
  him,
• 6:37
  we
• 6:38
  have
• 6:38
  two
• 6:38
  juicy
• 6:38
  oranges
• 6:39
  related
• 6:39
  to
• 6:39
  cannabis
• 6:40
  use
• 6:41
  and
• 6:41
  depressive
• 6:41
  use.
• 6:42
  Right.
• 6:42
  And
• 6:43
  from
• 6:43
  what
• 6:43
  we
• 6:43
  can
• 6:43
  tell,
• 6:44
  he
• 6:44
  hasn't
• 6:44
  been
• 6:44
  hospitalized.
• 6:45
  He
• 6:45
  hasn't
• 6:46
  endorsed
• 6:46
  any
• 6:46
  mania,
• 6:47
  psychosis,
• 6:48
  or
• 6:48
  suicide
• 6:49
  attempts.
• 6:49
  His
• 6:49
  trauma
• 6:50
  history
• 6:50
  is
• 6:50
  something
• 6:51
  we
• 6:51
  definitely
• 6:51
  wanna
• 6:52
  understand.
• 6:53
  That
• 6:53
  is
• 6:53
  standard.
• 6:54
  Make
• 6:54
  sure
• 6:54
  you
• 6:54
  never
• 6:55
  ignore
• 6:55
  that.
• 6:55
  It's
• 6:56
  always
• 6:56
  going
• 6:56
  to
• 6:56
  be
• 6:57
  critical
• 6:57
  information.
• 6:58
  anytime
• 6:59
  a
• 6:59
  patient
• 6:59
  tells
• 6:59
  you
• 6:59
  they
• 7:00
  have
• 7:00
  a
• 7:00
  trauma
• 7:00
  history,
• 7:00
  psychotherapy
• 7:01
  is
• 7:01
  of
• 7:02
  course
• 7:02
  on
• 7:02
  the
• 7:02
  table
• 7:02
  and
• 7:03
  it
• 7:03
  will
• 7:03
  make
• 7:03
  Benny's
• 7:04
  life
• 7:04
  a
• 7:04
  lot
• 7:04
  easier
• 7:05
  and
• 7:06
  your
• 7:06
  life
• 7:06
  a
• 7:06
  lot
• 7:07
  easier
• 7:07
  because
• 7:07
  you
• 7:07
  want
• 7:08
  your
• 7:08
  patients
• 7:08
  to
• 7:08
  be
• 7:09
  as
• 7:09
  healthy
• 7:10
  and
• 7:10
  empowered
• 7:11
  as
• 7:11
  possible.
• 7:12
  So,
• 7:13
  here
• 7:13
  we
• 7:13
  are
• 7:13
  with
• 7:13
  two
• 7:13
  juicy
• 7:14
  oranges.
• 7:15
  We
• 7:15
  have
• 7:15
  the
• 7:15
  depression
• 7:16
  and
• 7:17
  the
• 7:17
  cannabis
• 7:18
  Now.
• 7:19
  If
• 7:19
  you're
• 7:19
  thinking
• 7:20
  this,
• 7:20
  you
• 7:20
  are
• 7:21
  correct.
• 7:22
  We've
• 7:22
  really
• 7:23
  gotta
• 7:23
  understand
• 7:24
  the
• 7:24
  relationship
• 7:24
  here,
• 7:25
  what
• 7:25
  came
• 7:25
  first.
• 7:26
  Now,
• 7:26
  I
• 7:26
  will
• 7:27
  tell
• 7:27
  you
• 7:27
  folks,
• 7:28
  you
• 7:28
  can
• 7:28
  read
• 7:28
  this
• 7:29
  in
• 7:29
  your
• 7:29
  textbooks
• 7:30
  all
• 7:30
  day.
• 7:31
  No
• 7:31
  matter
• 7:31
  what
• 7:32
  your
• 7:32
  professors
• 7:32
  say,
• 7:33
  no
• 7:33
  matter
• 7:33
  what
• 7:33
  your
• 7:34
  preceptors
• 7:34
  say,
• 7:35
  it
• 7:35
  is
• 7:36
  not
• 7:36
  always
• 7:36
  easy
• 7:37
  to
• 7:37
  sniff
• 7:38
  out.
• 7:38
  What
• 7:39
  came
• 7:39
  first,
• 7:40
  the
• 7:40
  mood
• 7:40
  episode
• 7:41
  or
• 7:41
  the
• 7:41
  substance
• 7:42
  use?
• 7:43
  And
• 7:43
  I'll
• 7:43
  be
• 7:43
  honest
• 7:43
  with
• 7:43
  you,
• 7:44
  it's
• 7:44
  not
• 7:44
  always
• 7:44
  easy
• 7:44
  for
• 7:45
  beanbag
• 7:45
  Benny,
• 7:46
  to
• 7:46
  tell
• 7:46
  you
• 7:46
  what
• 7:47
  came
• 7:47
  first,
• 7:48
  his
• 7:48
  substance
• 7:49
  use.
• 7:49
  Or
• 7:50
  his
• 7:50
  mood
• 7:51
  episodes.
• 7:52
  it's
• 7:52
  complicated
• 7:53
  because,
• 7:55
  not
• 7:55
  everybody
• 7:56
  journals
• 7:57
  for
• 7:57
  every
• 7:57
  year
• 7:57
  of
• 7:57
  their
• 7:58
  life
• 7:58
  Nobody
• 7:58
  has
• 7:59
  that
• 7:59
  kind
• 7:59
  of
• 7:59
  rich
• 7:59
  information
• 8:00
  on
• 8:00
  them.
• 8:01
  it
• 8:01
  would
• 8:01
  be
• 8:01
  wonderful
• 8:01
  if
• 8:01
  they
• 8:02
  did,
• 8:02
  but
• 8:02
  when
• 8:03
  you
• 8:03
  ask
• 8:03
  this
• 8:03
  in
• 8:03
  practice,
• 8:04
  you
• 8:04
  usually
• 8:05
  don't
• 8:05
  get
• 8:05
  this
• 8:05
  concrete
• 8:06
  answer.
• 8:06
  in
• 8:07
  reality,
• 8:08
  you've
• 8:08
  gotta
• 8:09
  kind
• 8:09
  of
• 8:09
  anchor
• 8:10
  your
• 8:10
  questions
• 8:11
  toward
• 8:11
  life
• 8:11
  events.
• 8:12
  that
• 8:12
  helps
• 8:12
  a
• 8:12
  lot
• 8:12
  instead
• 8:13
  of
• 8:13
  saying,
• 8:13
  how
• 8:14
  old
• 8:14
  were
• 8:14
  you
• 8:14
  when
• 8:14
  you
• 8:15
  first
• 8:15
  started
• 8:15
  cannabis?
• 8:16
  Or
• 8:16
  how
• 8:16
  old
• 8:17
  were
• 8:17
  you
• 8:17
  when
• 8:17
  you
• 8:17
  were
• 8:17
  first
• 8:17
  depressed?
• 8:18
  Sometimes
• 8:19
  with.
• 8:19
  Folks
• 8:20
  like
• 8:20
  Beanbag
• 8:20
  Benny,
• 8:21
  who
• 8:21
  have
• 8:21
  been
• 8:22
  depressed
• 8:22
  since
• 8:22
  the
• 8:22
  age
• 8:22
  of
• 8:23
  15.
• 8:23
  It's
• 8:23
  good
• 8:24
  to
• 8:24
  ask
• 8:24
  them,
• 8:24
  what
• 8:25
  grade
• 8:25
  were
• 8:25
  you
• 8:25
  in
• 8:26
  when
• 8:26
  you
• 8:26
  felt
• 8:26
  down
• 8:26
  for
• 8:27
  the
• 8:27
  first
• 8:27
  time
• 8:27
  when
• 8:27
  life
• 8:28
  started
• 8:28
  looking
• 8:28
  a
• 8:29
  little
• 8:29
  bleak
• 8:29
  for
• 8:29
  you?
• 8:30
  You
• 8:30
  know,
• 8:30
  how
• 8:31
  were
• 8:31
  you
• 8:31
  in
• 8:31
  high
• 8:32
  school?
• 8:32
  If
• 8:33
  he
• 8:33
  tells
• 8:33
  you
• 8:33
  he's
• 8:33
  a
• 8:33
  basketball
• 8:34
  player,
• 8:35
  you
• 8:35
  know,
• 8:35
  did
• 8:35
  you,
• 8:35
  were
• 8:35
  you
• 8:35
  feeling
• 8:36
  this
• 8:36
  way?
• 8:37
  When
• 8:37
  you
• 8:37
  used
• 8:38
  to
• 8:38
  play
• 8:38
  basketball,
• 8:39
  you
• 8:39
  know,
• 8:40
  when
• 8:40
  did
• 8:40
  you
• 8:40
  start
• 8:40
  getting
• 8:41
  into
• 8:41
  weed?
• 8:41
  was
• 8:42
  it
• 8:42
  around
• 8:42
  the
• 8:42
  time
• 8:42
  that
• 8:43
  you
• 8:43
  started
• 8:43
  shooting
• 8:44
  hoops?
• 8:44
  it's
• 8:45
  very
• 8:45
  difficult
• 8:45
  for
• 8:45
  me,
• 8:46
  but
• 8:46
  I'm
• 8:46
  always
• 8:46
  trying
• 8:46
  to
• 8:46
  talk
• 8:47
  the
• 8:47
  lingo
• 8:48
  of
• 8:48
  a
• 8:48
  teenager,
• 8:49
  you
• 8:49
  know?
• 8:49
  Now
• 8:49
  I
• 8:49
  know
• 8:49
  Beanbag,
• 8:50
  Benny's
• 8:50
  a
• 8:50
  little
• 8:51
  older.
• 8:51
  He
• 8:51
  is
• 8:51
  34,
• 8:52
  but
• 8:52
  he's
• 8:52
  first
• 8:53
  started
• 8:53
  having
• 8:53
  symptoms
• 8:54
  when
• 8:54
  he
• 8:54
  was
• 8:54
  a
• 8:54
  teenager.
• 8:55
  what
• 8:55
  I'm
• 8:55
  trying
• 8:55
  to
• 8:55
  tell
• 8:56
  you
• 8:56
  all
• 8:56
  is
• 8:56
  match
• 8:57
  the
• 8:57
  verbiage
• 8:58
  of
• 8:58
  your
• 8:58
  patient,
• 8:58
  if
• 8:58
  you
• 8:58
  can.
• 8:59
  If
• 8:59
  he
• 8:59
  talks
• 8:59
  basketball.
• 9:01
  Try
• 9:01
  to
• 9:01
  make
• 9:01
  your
• 9:02
  lingo
• 9:02
  a
• 9:02
  little
• 9:02
  more
• 9:03
  in
• 9:03
  the
• 9:03
  basketball
• 9:04
  arena,
• 9:05
  No
• 9:05
  pun
• 9:05
  intended,
• 9:06
  right?
• 9:06
  try
• 9:07
  to
• 9:08
  match
• 9:08
  the
• 9:08
  age.
• 9:09
  Don't
• 9:09
  use
• 9:10
  verbiage
• 9:11
  that
• 9:11
  you
• 9:11
  would
• 9:11
  use
• 9:12
  talking
• 9:13
  to,
• 9:14
  Kant
• 9:15
  or
• 9:16
  Socrates,
• 9:17
  Use
• 9:17
  verbiage
• 9:18
  that
• 9:18
  matches
• 9:19
  where
• 9:19
  your
• 9:19
  patient
• 9:19
  is
• 9:20
  in
• 9:20
  their
• 9:20
  lives.
• 9:21
  this
• 9:21
  is
• 9:21
  a
• 9:22
  young
• 9:22
  professional.
• 9:23
  He
• 9:24
  loves
• 9:24
  sports.
• 9:25
  Just
• 9:25
  talk
• 9:26
  to
• 9:26
  him
• 9:26
  like
• 9:26
  a
• 9:26
  regular
• 9:27
  Joe,
• 9:27
  maybe.
• 9:27
  It's
• 9:28
  clear
• 9:28
  beanbag.
• 9:29
  Benny
• 9:29
  is
• 9:29
  telling
• 9:30
  you
• 9:30
  his
• 9:30
  first
• 9:30
  depressive
• 9:31
  episode
• 9:31
  was
• 9:31
  in
• 9:32
  his
• 9:32
  teens.
• 9:32
  He
• 9:32
  was
• 9:32
  a
• 9:32
  sophomore,
• 9:33
  junior
• 9:34
  in
• 9:34
  high
• 9:34
  school
• 9:35
  and
• 9:35
  he
• 9:35
  didn't
• 9:35
  start
• 9:35
  smoking
• 9:36
  pot
• 9:36
  till
• 9:36
  college.
• 9:37
  So
• 9:37
  we
• 9:37
  actually
• 9:38
  do
• 9:38
  have
• 9:38
  proof
• 9:38
  here
• 9:39
  that
• 9:39
  the
• 9:39
  depression
• 9:40
  preceded
• 9:40
  cannabis.
• 9:41
  Now,
• 9:41
  this
• 9:42
  is
• 9:42
  kind
• 9:42
  of
• 9:42
  important
• 9:43
  because
• 9:43
  it
• 9:44
  leads
• 9:44
  us
• 9:44
  to
• 9:44
  believe
• 9:45
  with
• 9:46
  some
• 9:46
  good
• 9:46
  reason
• 9:47
  that
• 9:48
  we've
• 9:48
  gotta
• 9:48
  treat
• 9:49
  his
• 9:49
  depressive
• 9:49
  symptoms
• 9:50
  Maybe
• 9:51
  his
• 9:52
  cannabis
• 9:52
  use
• 9:52
  is
• 9:52
  a
• 9:53
  manifestation
• 9:54
  of
• 9:54
  untreated
• 9:55
  depression
• 9:56
  or
• 9:56
  depression
• 9:57
  that
• 9:57
  is
• 9:57
  suboptimally
• 9:58
  treated.
• 9:58
  Typically,
• 9:59
  when
• 9:59
  my
• 9:59
  patients
• 10:00
  tell
• 10:00
  me
• 10:00
  they're
• 10:01
  abusing
• 10:01
  cannabis,
• 10:02
  especially
• 10:03
  if
• 10:03
  I'm
• 10:03
  already
• 10:03
  treating
• 10:04
  them
• 10:04
  for
• 10:04
  quite
• 10:04
  some
• 10:04
  time,
• 10:05
  I
• 10:06
  will
• 10:06
  blame
• 10:06
  myself.
• 10:07
  I
• 10:07
  will
• 10:07
  start
• 10:08
  taking
• 10:08
  blame
• 10:09
  and
• 10:09
  say,
• 10:09
  Hey,
• 10:09
  I,
• 10:10
  I
• 10:10
  don't
• 10:11
  want
• 10:11
  you
• 10:11
  to
• 10:11
  feel
• 10:11
  bad
• 10:11
  for
• 10:12
  your
• 10:12
  cannabis
• 10:12
  use.
• 10:13
  I
• 10:13
  feel
• 10:14
  as
• 10:14
  though,
• 10:15
  I
• 10:15
  need
• 10:15
  to
• 10:15
  be
• 10:15
  doing
• 10:16
  more.
• 10:16
  and
• 10:16
  you
• 10:16
  don't
• 10:17
  wanna
• 10:17
  have
• 10:17
  this
• 10:17
  hero
• 10:17
  complex.
• 10:18
  But
• 10:18
  what
• 10:19
  I
• 10:19
  try
• 10:19
  to
• 10:19
  say
• 10:19
  to
• 10:19
  my
• 10:20
  patients
• 10:20
  is,
• 10:21
  you
• 10:21
  know,
• 10:21
  don't
• 10:22
  beat
• 10:22
  yourself
• 10:22
  up
• 10:22
  for
• 10:22
  cannabis
• 10:23
  use.
• 10:23
  We're
• 10:24
  all
• 10:24
  in
• 10:24
  this
• 10:24
  together.
• 10:25
  We're
• 10:25
  struggling.
• 10:26
  Let's
• 10:26
  work
• 10:27
  together
• 10:27
  on
• 10:28
  trying
• 10:29
  to
• 10:29
  address
• 10:29
  why
• 10:30
  cannabis
• 10:31
  is
• 10:31
  still
• 10:31
  so
• 10:32
  appealing
• 10:32
  to
• 10:32
  you.
• 10:33
  maybe
• 10:34
  it's
• 10:34
  because.
• 10:35
  I
• 10:35
  need
• 10:36
  to
• 10:37
  work
• 10:37
  with
• 10:37
  you
• 10:37
  more
• 10:38
  on
• 10:39
  some
• 10:39
  of
• 10:39
  these
• 10:39
  depressive
• 10:40
  symptoms.
• 10:40
  a
• 10:40
  lot
• 10:40
  of
• 10:40
  your
• 10:41
  patients
• 10:41
  who
• 10:41
  are
• 10:41
  depressed,
• 10:42
  already
• 10:42
  feel
• 10:43
  guilty
• 10:43
  enough,
• 10:43
  they
• 10:43
  already
• 10:44
  feel
• 10:45
  pretty
• 10:45
  down
• 10:45
  on
• 10:45
  themselves,
• 10:46
  and
• 10:46
  some
• 10:46
  of
• 10:46
  them
• 10:46
  lack
• 10:47
  a
• 10:47
  lot
• 10:47
  of
• 10:47
  self-confidence.
• 10:48
  It's
• 10:48
  part
• 10:49
  Of
• 10:49
  depression
• 10:50
  itself.
• 10:51
  So
• 10:51
  I
• 10:51
  like
• 10:51
  to
• 10:52
  reframe
• 10:52
  this
• 10:52
  as,
• 10:53
  you
• 10:53
  know,
• 10:53
  this
• 10:53
  isn't
• 10:53
  your
• 10:53
  fault.
• 10:54
  You're
• 10:54
  trying
• 10:54
  to
• 10:54
  do
• 10:54
  whatever
• 10:55
  you
• 10:55
  can
• 10:55
  to
• 10:55
  feel
• 10:55
  better
• 10:56
  with
• 10:56
  the
• 10:56
  tools
• 10:56
  you
• 10:57
  have.
• 10:57
  the
• 10:57
  fact
• 10:58
  that
• 10:58
  his
• 10:58
  depression
• 10:58
  came
• 10:59
  first,
• 11:00
  either
• 11:00
  way,
• 11:00
  I
• 11:00
  would
• 11:00
  say,
• 11:01
  right?
• 11:01
  You're
• 11:01
  looking
• 11:01
  at
• 11:02
  depression,
• 11:02
  you're
• 11:02
  looking
• 11:02
  at
• 11:02
  cannabis.
• 11:03
  You
• 11:03
  really
• 11:03
  wanna
• 11:04
  get
• 11:04
  both
• 11:04
  of
• 11:04
  these
• 11:05
  things
• 11:05
  out
• 11:05
  of
• 11:05
  his
• 11:05
  way,
• 11:06
  the
• 11:06
  best
• 11:07
  you
• 11:07
  can.
• 11:08
  Right.
• 11:08
  And
• 11:09
  he's
• 11:09
  dropping
• 11:10
  some
• 11:10
  clues
• 11:10
  about
• 11:11
  Prozac,
• 11:11
  saying
• 11:11
  it
• 11:12
  had
• 11:12
  bedroom
• 11:12
  effects.
• 11:13
  So
• 11:13
  as
• 11:14
  your
• 11:14
  patients
• 11:14
  are
• 11:14
  telling
• 11:15
  you
• 11:15
  this,
• 11:15
  start
• 11:16
  taking
• 11:16
  mental
• 11:17
  notes
• 11:17
  and
• 11:18
  when
• 11:18
  he
• 11:18
  tells
• 11:18
  you
• 11:18
  the
• 11:18
  bedroom
• 11:19
  side
• 11:19
  effects,
• 11:20
  you
• 11:20
  don't
• 11:20
  have
• 11:21
  to
• 11:21
  go
• 11:21
  down
• 11:21
  the
• 11:21
  rabbit
• 11:22
  hole
• 11:22
  right
• 11:22
  away.
• 11:22
  What
• 11:23
  were
• 11:23
  those
• 11:23
  effects?
• 11:23
  was
• 11:23
  it
• 11:24
  a
• 11:24
  lack
• 11:24
  of
• 11:24
  arousal?
• 11:25
  Did
• 11:26
  you
• 11:26
  have
• 11:26
  difficulty
• 11:27
  achieving
• 11:27
  climax?
• 11:28
  You
• 11:28
  don't
• 11:28
  necessarily
• 11:28
  have
• 11:29
  to
• 11:29
  go
• 11:29
  there
• 11:29
  right
• 11:29
  away,
• 11:30
  but
• 11:30
  keep
• 11:30
  it
• 11:30
  in
• 11:31
  your
• 11:31
  back
• 11:31
  pocket
• 11:32
  He
• 11:32
  has
• 11:32
  bedroom
• 11:33
  side
• 11:33
  effects
• 11:34
  so
• 11:34
  the
• 11:34
  kind
• 11:35
  of
• 11:35
  medication
• 11:36
  you
• 11:36
  may
• 11:36
  choose
• 11:37
  as
• 11:37
  your
• 11:38
  evaluation
• 11:39
  evolves
• 11:40
  may
• 11:41
  gravitate
• 11:41
  towards
• 11:42
  those
• 11:42
  medications
• 11:43
  that
• 11:43
  don't
• 11:43
  cause
• 11:43
  sexual
• 11:44
  side
• 11:44
  effects.
• 11:44
  So
• 11:44
  immediately
• 11:46
  I'm
• 11:46
  thinking
• 11:47
  Remeron.
• 11:48
  I'm
• 11:48
  thinking
• 11:49
  Wellbutrin,
• 11:50
  both
• 11:50
  of
• 11:50
  which
• 11:50
  counter
• 11:51
  sexual
• 11:51
  side
• 11:51
  effects.
• 11:52
  You
• 11:52
  could
• 11:52
  think
• 11:52
  bus
• 11:53
  bro,
• 11:53
  but
• 11:53
  bus
• 11:53
  bro's
• 11:54
  not
• 11:54
  really
• 11:54
  indicated
• 11:54
  for
• 11:55
  depression.
• 11:56
  It's
• 11:56
  indicated
• 11:56
  for
• 11:56
  anxiety
• 11:57
  and
• 11:57
  he's
• 11:57
  not
• 11:58
  coming
• 11:58
  to
• 11:58
  you
• 11:58
  for
• 11:59
  anxiety.
• 11:59
  He's
• 12:00
  coming
• 12:00
  to
• 12:00
  you
• 12:00
  for
• 12:00
  depression.
• 12:01
  so
• 12:01
  again,
• 12:02
  I'm
• 12:02
  just
• 12:03
  trying
• 12:03
  to
• 12:03
  think
• 12:03
  out
• 12:03
  loud
• 12:04
  for
• 12:04
  you
• 12:04
  folks
• 12:05
  out
• 12:05
  there
• 12:05
  who
• 12:05
  are
• 12:05
  beginning
• 12:06
  to
• 12:06
  practice
• 12:06
  it's
• 12:07
  all
• 12:07
  a
• 12:07
  fascinating
• 12:08
  world.
• 12:08
  It's
• 12:08
  a
• 12:08
  puzzle
• 12:09
  piece.
• 12:09
  It's
• 12:09
  interesting.
• 12:11
  so
• 12:11
  when
• 12:11
  he
• 12:11
  tells
• 12:12
  you
• 12:12
  bedroom
• 12:12
  side
• 12:13
  effects,
• 12:13
  start
• 12:14
  putting.
• 12:15
  Those
• 12:15
  medications
• 12:16
  on
• 12:16
  the
• 12:16
  mantle
• 12:16
  that
• 12:16
  are
• 12:16
  notoriously
• 12:18
  better
• 12:18
  for
• 12:19
  somebody
• 12:19
  who
• 12:19
  complains
• 12:20
  of
• 12:20
  sexual
• 12:20
  side
• 12:20
  effects.
• 12:21
  that
• 12:21
  would
• 12:21
  be
• 12:21
  the
• 12:21
  wellbutrins,
• 12:22
  the
• 12:22
  remands,
• 12:23
  and
• 12:23
  the
• 12:23
  abuse
• 12:23
  bones.
• 12:24
  Now,
• 12:25
  now
• 12:25
  we,
• 12:26
  when
• 12:26
  it
• 12:26
  comes
• 12:27
  to
• 12:27
  remiron,
• 12:27
  you
• 12:27
  wanna
• 12:28
  avoid
• 12:28
  that
• 12:28
  a
• 12:28
  little
• 12:29
  bit
• 12:29
  because
• 12:30
  remiron
• 12:31
  is
• 12:31
  a
• 12:31
  weight
• 12:31
  gainer.
• 12:32
  Now
• 12:33
  as
• 12:33
  you
• 12:33
  keep
• 12:34
  learning
• 12:34
  in
• 12:34
  your
• 12:34
  studies,
• 12:35
  this
• 12:35
  is
• 12:35
  gonna
• 12:35
  come
• 12:36
  more
• 12:36
  natural
• 12:36
  to
• 12:36
  you.
• 12:37
  You're
• 12:37
  not
• 12:37
  gonna
• 12:37
  have
• 12:37
  to
• 12:38
  whip
• 12:38
  out
• 12:38
  the
• 12:38
  textbook
• 12:38
  every
• 12:39
  time
• 12:39
  to
• 12:39
  remember
• 12:40
  that
• 12:40
  Remeron
• 12:40
  tends
• 12:41
  to
• 12:41
  cause
• 12:42
  weight
• 12:42
  gain,
• 12:42
  you
• 12:42
  already
• 12:43
  know
• 12:43
  he's
• 12:43
  snacking
• 12:44
  a
• 12:44
  lot.
• 12:44
  He's
• 12:44
  craving
• 12:44
  carbs.
• 12:45
  You
• 12:46
  might
• 12:46
  ask
• 12:46
  him
• 12:46
  about
• 12:46
  weight
• 12:47
  gain.
• 12:48
  And
• 12:48
  he
• 12:48
  might
• 12:48
  tell
• 12:48
  you,
• 12:49
  yeah,
• 12:49
  I've
• 12:49
  put
• 12:49
  on
• 12:50
  20
• 12:50
  pounds
• 12:50
  in
• 12:51
  the
• 12:51
  last
• 12:51
  month.
• 12:52
  So
• 12:52
  there
• 12:52
  goes
• 12:53
  remiron,
• 12:53
  right?
• 12:53
  You
• 12:53
  don't
• 12:53
  wanna
• 12:54
  add
• 12:54
  to
• 12:54
  that
• 12:54
  problem.
• 12:55
  That's
• 12:55
  not
• 12:55
  gonna
• 12:55
  help
• 12:56
  him,
• 12:56
  especially
• 12:56
  if
• 12:56
  he's
• 12:57
  not
• 12:57
  ready
• 12:57
  to
• 12:58
  stop
• 12:58
  using
• 12:58
  cannabis.
• 12:59
  So
• 12:59
  again,
• 13:00
  I'm
• 13:00
  just
• 13:00
  thinking
• 13:01
  out
• 13:01
  loud
• 13:01
  that
• 13:02
  the
• 13:02
  Wellbutrin
• 13:02
  might
• 13:03
  be
• 13:03
  the
• 13:03
  best
• 13:03
  idea
• 13:04
  so
• 13:04
  far.
• 13:04
  He
• 13:04
  is
• 13:04
  also
• 13:05
  tried
• 13:05
  an
• 13:05
  SSRI.
• 13:06
  He's
• 13:06
  tried
• 13:07
  Prozac.
• 13:08
  Now
• 13:08
  your
• 13:08
  textbooks
• 13:08
  might
• 13:09
  say,
• 13:09
  well
• 13:09
  try
• 13:09
  an
• 13:09
  SSRI
• 13:10
  then
• 13:10
  try
• 13:10
  another
• 13:11
  SSRI.
• 13:12
  And
• 13:12
  that's
• 13:12
  not
• 13:12
  wrong.
• 13:13
  it
• 13:13
  is
• 13:13
  evidence-based.
• 13:14
  If
• 13:14
  you
• 13:14
  wanted
• 13:14
  to
• 13:14
  go
• 13:14
  from
• 13:15
  Prozac
• 13:15
  to
• 13:15
  Zoloft.
• 13:16
  That's
• 13:16
  fine.
• 13:18
  That's
• 13:18
  perfectly
• 13:18
  fine.
• 13:19
  But
• 13:19
  in
• 13:20
  reality,
• 13:21
  you're
• 13:21
  also
• 13:21
  treating
• 13:22
  a
• 13:22
  patient
• 13:22
  in
• 13:22
  front
• 13:22
  of
• 13:22
  you
• 13:23
  who
• 13:23
  has
• 13:23
  specific
• 13:23
  symptoms
• 13:24
  and
• 13:25
  you
• 13:25
  wanna
• 13:25
  pick
• 13:26
  medications
• 13:27
  with
• 13:27
  the
• 13:27
  right
• 13:27
  neurotransmitter
• 13:28
  profiles
• 13:29
  to
• 13:29
  address
• 13:30
  your
• 13:30
  patient's
• 13:30
  issues
• 13:31
  in
• 13:31
  front
• 13:31
  of
• 13:31
  you.
• 13:32
  That's
• 13:32
  really
• 13:33
  the
• 13:33
  key
• 13:33
  here.
• 13:33
  That's
• 13:33
  what
• 13:34
  we're
• 13:34
  doing
• 13:34
  here.
• 13:34
  I'm
• 13:35
  thinking
• 13:35
  Wellbutrin,
• 13:36
  that's
• 13:36
  just.
• 13:37
  going
• 13:37
  through
• 13:37
  my
• 13:38
  mind
• 13:38
  right
• 13:38
  now.
• 13:39
  I
• 13:39
  wanna
• 13:39
  see
• 13:39
  whether,
• 13:40
  if
• 13:40
  we
• 13:40
  can
• 13:40
  improve
• 13:41
  his
• 13:41
  fatigue,
• 13:41
  his
• 13:41
  lack
• 13:42
  of
• 13:42
  motivation,
• 13:43
  his
• 13:43
  oversleeping,
• 13:44
  if
• 13:44
  we
• 13:44
  can
• 13:45
  improve
• 13:45
  his
• 13:45
  mood,
• 13:46
  how
• 13:46
  inclined
• 13:47
  will
• 13:47
  he
• 13:48
  be
• 13:48
  to
• 13:48
  use
• 13:48
  cannabis?
• 13:49
  Now
• 13:49
  a
• 13:49
  great
• 13:50
  follow-up
• 13:50
  question
• 13:51
  for
• 13:51
  him,
• 13:51
  is
• 13:52
  to
• 13:52
  ask
• 13:52
  Benny,
• 13:53
  can
• 13:53
  you
• 13:53
  remember
• 13:54
  a
• 13:54
  time
• 13:55
  for
• 13:55
  at
• 13:55
  least
• 13:55
  30
• 13:55
  days
• 13:56
  or
• 13:56
  so
• 13:56
  when
• 13:56
  you
• 13:56
  weren't
• 13:57
  using
• 13:57
  cannabis?
• 13:58
  Oh
• 13:58
  yeah.
• 13:59
  I
• 13:59
  was
• 13:59
  a
• 13:59
  sophomore
• 14:00
  in
• 14:01
  college
• 14:02
  or
• 14:02
  right
• 14:02
  before
• 14:02
  I
• 14:02
  was
• 14:02
  a
• 14:03
  sophomore
• 14:03
  in
• 14:03
  college.
• 14:04
  that
• 14:04
  summer
• 14:04
  I
• 14:05
  wasn't
• 14:05
  using
• 14:05
  cannabis.
• 14:06
  Great.
• 14:06
  And
• 14:06
  can
• 14:06
  you
• 14:06
  remember
• 14:07
  how
• 14:07
  you
• 14:07
  felt
• 14:08
  at
• 14:08
  that
• 14:08
  time?
• 14:09
  Were
• 14:09
  you
• 14:09
  down,
• 14:09
  were
• 14:09
  you
• 14:10
  sad?
• 14:11
  Were
• 14:11
  you.
• 14:12
  Crying
• 14:12
  a
• 14:13
  lot.
• 14:13
  Were
• 14:13
  you
• 14:13
  sleeping
• 14:14
  in?
• 14:14
  Oh,
• 14:14
  you
• 14:14
  know,
• 14:14
  no.
• 14:15
  I
• 14:15
  was
• 14:15
  at
• 14:15
  my
• 14:15
  aunt's
• 14:16
  lake
• 14:16
  house
• 14:16
  that
• 14:16
  summer.
• 14:17
  I
• 14:17
  felt
• 14:17
  great
• 14:17
  actually,
• 14:18
  now
• 14:18
  that
• 14:18
  I
• 14:18
  think
• 14:19
  of
• 14:19
  it.
• 14:19
  So
• 14:19
  sometimes
• 14:20
  you
• 14:20
  have
• 14:20
  to
• 14:20
  guide
• 14:20
  the
• 14:20
  questions
• 14:21
  to
• 14:21
  bring
• 14:22
  your
• 14:22
  patients
• 14:22
  back
• 14:23
  to
• 14:24
  moments
• 14:24
  in
• 14:24
  their
• 14:25
  lives
• 14:25
  so
• 14:25
  they
• 14:25
  even
• 14:26
  have
• 14:26
  some
• 14:26
  perspective,
• 14:27
  right?
• 14:27
  Because
• 14:27
  you're
• 14:28
  not
• 14:28
  there
• 14:28
  to
• 14:28
  just
• 14:28
  lecture
• 14:29
  them
• 14:29
  and
• 14:29
  tell
• 14:29
  them
• 14:30
  what
• 14:30
  to
• 14:30
  do.
• 14:31
  The
• 14:31
  goal
• 14:31
  is
• 14:32
  guided
• 14:32
  questioning,
• 14:33
  guiding
• 14:34
  them
• 14:34
  in
• 14:34
  the
• 14:34
  direction
• 14:35
  of.
• 14:36
  Where
• 14:36
  their
• 14:37
  life
• 14:37
  is
• 14:37
  going
• 14:38
  and
• 14:38
  where
• 14:38
  it
• 14:38
  was
• 14:38
  before.
• 14:40
  every
• 14:40
  patient
• 14:40
  has
• 14:42
  this
• 14:42
  kind
• 14:43
  of
• 14:43
  buried
• 14:43
  gold
• 14:44
  treasure
• 14:45
  inside
• 14:45
  of
• 14:45
  them,
• 14:46
  right?
• 14:46
  your
• 14:46
  goal
• 14:46
  is
• 14:46
  to
• 14:46
  chisel
• 14:47
  that
• 14:47
  out
• 14:47
  and
• 14:48
  allow
• 14:48
  them
• 14:48
  to
• 14:48
  connect
• 14:48
  the
• 14:49
  dots.
• 14:49
  So
• 14:49
  lo
• 14:50
  and
• 14:50
  behold,
• 14:51
  you
• 14:51
  get
• 14:51
  to
• 14:51
  Benny.
• 14:52
  You
• 14:53
  get
• 14:53
  a
• 14:53
  question
• 14:53
  to
• 14:53
  Benny
• 14:54
  and
• 14:54
  he's
• 14:54
  answering
• 14:55
  you
• 14:55
  and
• 14:55
  he's
• 14:55
  saying,
• 14:55
  yeah,
• 14:56
  actually
• 14:57
  light
• 14:57
  bulb
• 14:57
  moment.
• 14:58
  I
• 14:58
  did
• 14:58
  feel
• 14:58
  a
• 14:58
  hell
• 14:59
  of
• 14:59
  a
• 14:59
  lot
• 14:59
  better
• 14:59
  that
• 14:59
  summer
• 15:00
  and
• 15:00
  no,
• 15:01
  oddly
• 15:01
  enough
• 15:02
  I
• 15:02
  hadn't
• 15:02
  started
• 15:02
  cannabis
• 15:03
  use
• 15:03
  yet.
• 15:04
  Right.
• 15:04
  And
• 15:04
  then
• 15:04
  he
• 15:04
  tells
• 15:04
  you,
• 15:05
  maybe
• 15:05
  I
• 15:05
  broke
• 15:05
  up
• 15:05
  with
• 15:06
  a
• 15:06
  girlfriend.
• 15:06
  And
• 15:06
  yeah,
• 15:07
  that's
• 15:07
  when
• 15:07
  I
• 15:07
  started,
• 15:08
  and
• 15:08
  then
• 15:08
  I
• 15:08
  just
• 15:08
  kind
• 15:08
  of
• 15:08
  kept
• 15:09
  smoking
• 15:09
  cannabis.
• 15:10
  Okay.
• 15:11
  Well,
• 15:12
  now
• 15:12
  we
• 15:12
  have
• 15:12
  some,
• 15:13
  situational
• 15:14
  triggers
• 15:15
  and
• 15:15
  those
• 15:15
  are
• 15:15
  good
• 15:15
  follow
• 15:16
  up
• 15:16
  questions
• 15:16
  to
• 15:16
  ask
• 15:17
  What
• 15:17
  triggers
• 15:18
  you
• 15:18
  to
• 15:18
  use
• 15:18
  cannabis?
• 15:19
  How
• 15:19
  do
• 15:19
  you
• 15:20
  feel
• 15:20
  immediately
• 15:20
  after
• 15:21
  you
• 15:21
  use
• 15:22
  it?
• 15:22
  What
• 15:22
  are
• 15:22
  some
• 15:23
  of
• 15:23
  the
• 15:23
  things
• 15:23
  you
• 15:24
  feel
• 15:24
  it's
• 15:24
  doing
• 15:25
  for
• 15:25
  you?
• 15:25
  motivational
• 15:26
  interviewing
• 15:26
  is
• 15:26
  all
• 15:27
  about
• 15:27
  eliciting
• 15:28
  conversations
• 15:30
  that
• 15:30
  spark
• 15:30
  change
• 15:31
  The
• 15:31
  more
• 15:32
  you
• 15:32
  can
• 15:32
  have
• 15:33
  Benny
• 15:33
  talk
• 15:34
  about
• 15:35
  reasons
• 15:35
  to
• 15:35
  change,
• 15:36
  but
• 15:36
  he
• 15:36
  has
• 15:36
  to
• 15:36
  talk
• 15:37
  about
• 15:37
  them,
• 15:37
  not
• 15:37
  you.
• 15:38
  in
• 15:38
  motivational
• 15:39
  interviewing,
• 15:39
  the
• 15:39
  more
• 15:40
  he
• 15:40
  can
• 15:40
  talk
• 15:41
  about
• 15:42
  reasons
• 15:43
  he
• 15:43
  should
• 15:43
  change
• 15:43
  out
• 15:44
  loud
• 15:44
  as
• 15:44
  you
• 15:44
  elicit
• 15:45
  those
• 15:45
  answers
• 15:46
  out
• 15:46
  of
• 15:46
  him.
• 15:46
  The
• 15:47
  greater
• 15:47
  the
• 15:47
  chance
• 15:47
  he
• 15:47
  actually
• 15:48
  will.
• 15:48
  My
• 15:49
  greater
• 15:49
  point
• 15:49
  is
• 15:50
  you
• 15:50
  don't
• 15:50
  wanna
• 15:50
  harp
• 15:50
  too
• 15:51
  long
• 15:51
  on
• 15:52
  all
• 15:52
  of
• 15:52
  the
• 15:52
  reasons
• 15:53
  he
• 15:53
  uses
• 15:53
  cannabis
• 15:54
  and
• 15:54
  how
• 15:54
  it
• 15:54
  helps
• 15:54
  with
• 15:54
  his
• 15:54
  anxiety
• 15:55
  and
• 15:55
  this
• 15:55
  and
• 15:56
  that.
• 15:56
  you
• 15:56
  actually
• 15:57
  wanna
• 15:57
  first
• 15:57
  sort
• 15:57
  of
• 15:58
  understand
• 15:58
  that
• 15:59
  because
• 15:59
  you
• 15:59
  have
• 16:00
  to
• 16:00
  understand
• 16:00
  it
• 16:01
  so
• 16:01
  that
• 16:02
  you
• 16:02
  can
• 16:02
  tailor
• 16:02
  your
• 16:02
  medications
• 16:04
  in
• 16:04
  a
• 16:04
  way
• 16:04
  that
• 16:05
  you're
• 16:05
  addressing
• 16:06
  those
• 16:06
  reasons
• 16:06
  he
• 16:06
  uses
• 16:07
  so
• 16:07
  that
• 16:07
  he
• 16:07
  doesn't
• 16:08
  use
• 16:08
  anymore.
• 16:08
  If
• 16:08
  that
• 16:08
  makes
• 16:09
  sense,
• 16:09
  right?
• 16:09
  I'm
• 16:09
  just
• 16:10
  down
• 16:10
  all
• 16:10
  the
• 16:10
  time.
• 16:10
  I'm
• 16:10
  sad
• 16:11
  all
• 16:11
  the
• 16:11
  time,
• 16:11
  and
• 16:11
  it's
• 16:12
  just
• 16:12
  something
• 16:12
  to
• 16:12
  do.
• 16:12
  Well
• 16:13
  then
• 16:13
  target
• 16:13
  him
• 16:14
  feeling
• 16:14
  down
• 16:14
  and
• 16:14
  sad,
• 16:15
  right?
• 16:16
  If
• 16:16
  he's
• 16:16
  super
• 16:16
  anxious
• 16:17
  and
• 16:17
  that's
• 16:17
  why
• 16:17
  he's
• 16:17
  using
• 16:18
  cannabis
• 16:18
  fix
• 16:19
  up
• 16:19
  his
• 16:19
  anxiety.
• 16:20
  But
• 16:21
  you
• 16:21
  wanna
• 16:22
  understand
• 16:22
  why
• 16:23
  he's
• 16:23
  using
• 16:25
  and
• 16:25
  you
• 16:26
  also
• 16:26
  wanna
• 16:26
  elicit
• 16:28
  other
• 16:29
  things,
• 16:30
  like
• 16:31
  why
• 16:32
  he
• 16:32
  feels
• 16:32
  he
• 16:32
  has
• 16:33
  to
• 16:33
  use
• 16:33
  it.
• 16:34
  In
• 16:35
  certain
• 16:35
  contexts,
• 16:36
  right?
• 16:37
  What
• 16:37
  triggers
• 16:38
  it?
• 16:39
  you
• 16:39
  wanna
• 16:39
  ask
• 16:40
  him
• 16:40
  how
• 16:40
  he
• 16:40
  feels
• 16:41
  afterwards.
• 16:41
  Maybe
• 16:42
  he
• 16:42
  feels
• 16:42
  two
• 16:43
  or
• 16:43
  three
• 16:43
  days
• 16:43
  later
• 16:43
  really
• 16:44
  anxious
• 16:44
  and
• 16:44
  really
• 16:45
  down
• 16:45
  and
• 16:46
  he
• 16:46
  just
• 16:46
  doesn't
• 16:46
  feel
• 16:47
  good.
• 16:47
  And
• 16:47
  maybe
• 16:48
  there's
• 16:49
  a
• 16:49
  lot
• 16:49
  of
• 16:49
  withdrawal
• 16:50
  here.
• 16:50
  So
• 16:50
  you
• 16:50
  gotta
• 16:51
  think
• 16:51
  about
• 16:51
  that
• 16:51
  too,
• 16:52
  right?
• 16:52
  Because,
• 16:53
  and
• 16:53
  this
• 16:53
  is
• 16:53
  what
• 16:53
  gets
• 16:54
  so
• 16:54
  darn
• 16:54
  complicated
• 16:55
  with
• 16:55
  cannabis,
• 16:56
  is
• 16:56
  that
• 16:56
  there's
• 16:57
  a
• 16:57
  withdrawal
• 16:57
  period
• 16:58
  and
• 16:59
  it
• 16:59
  makes
• 16:59
  you
• 16:59
  feel
• 16:59
  irritable
• 17:00
  and
• 17:00
  kind
• 17:00
  of
• 17:00
  dysphoric.
• 17:01
  And
• 17:01
  we
• 17:02
  don't
• 17:02
  really
• 17:02
  know.
• 17:02
  Right?
• 17:03
  He
• 17:03
  could
• 17:03
  be
• 17:03
  coming
• 17:03
  to
• 17:03
  you
• 17:04
  and
• 17:04
  he
• 17:04
  hasn't
• 17:04
  smoked
• 17:05
  a
• 17:05
  joint
• 17:05
  in
• 17:06
  18
• 17:06
  hours
• 17:06
  or
• 17:07
  something,
• 17:07
  or
• 17:07
  three
• 17:08
  days,
• 17:08
  and
• 17:08
  he's
• 17:08
  maybe
• 17:09
  isn't
• 17:09
  even
• 17:09
  paying
• 17:10
  that
• 17:10
  much
• 17:10
  attention
• 17:11
  to
• 17:11
  when
• 17:11
  he's
• 17:11
  using,
• 17:12
  you
• 17:12
  know,
• 17:12
  it's
• 17:12
  not
• 17:12
  like
• 17:12
  he's
• 17:13
  journaling
• 17:13
  about
• 17:13
  this.
• 17:14
  So
• 17:14
  you
• 17:15
  could
• 17:15
  have
• 17:15
  a
• 17:15
  patient
• 17:16
  like
• 17:16
  beanbag
• 17:16
  Benny,
• 17:17
  who's
• 17:17
  using
• 17:18
  cannabis
• 17:18
  occasionally
• 17:19
  as
• 17:19
  he
• 17:19
  says
• 17:20
  but
• 17:20
  at
• 17:20
  the
• 17:20
  same
• 17:20
  time
• 17:21
  that
• 17:22
  occasionally.
• 17:23
  verbiage
• 17:24
  is
• 17:24
  so
• 17:25
  slippery
• 17:25
  and
• 17:25
  unpredictable
• 17:26
  you
• 17:27
  might
• 17:27
  see
• 17:27
  him
• 17:27
  and
• 17:28
  you
• 17:28
  might
• 17:28
  think
• 17:28
  his
• 17:28
  depression's
• 17:29
  getting
• 17:29
  worse
• 17:29
  and
• 17:29
  he's
• 17:29
  really
• 17:30
  just
• 17:31
  stopped
• 17:31
  using
• 17:31
  cannabis
• 17:32
  for
• 17:32
  a
• 17:32
  few
• 17:32
  days
• 17:33
  and
• 17:33
  it's
• 17:34
  just
• 17:34
  so
• 17:34
  complicated.
• 17:36
  So
• 17:36
  that's
• 17:38
  what
• 17:38
  we're
• 17:38
  looking
• 17:39
  at
• 17:39
  here,
• 17:39
  it
• 17:39
  gets
• 17:39
  so
• 17:40
  slippery
• 17:40
  Say
• 17:40
  to
• 17:41
  my
• 17:41
  friends,
• 17:42
  cannabis
• 17:42
  really
• 17:43
  muddies
• 17:44
  the
• 17:44
  water.
• 17:44
  at
• 17:44
  least
• 17:45
  for
• 17:45
  me,
• 17:45
  this
• 17:46
  podcast
• 17:46
  is
• 17:46
  about
• 17:47
  my
• 17:47
  perspective
• 17:48
  sharing
• 17:48
  with
• 17:48
  you,
• 17:49
  creating
• 17:50
  a
• 17:50
  community
• 17:50
  for
• 17:50
  us
• 17:51
  to
• 17:51
  talk
• 17:51
  about
• 17:51
  this
• 17:52
  and
• 17:52
  prepare
• 17:52
  you
• 17:52
  for
• 17:52
  what
• 17:53
  real
• 17:54
  life
• 17:56
  psychiatry
• 17:57
  looks
• 17:57
  like.
• 17:57
  for
• 17:57
  me.
• 17:59
  cannabis
• 17:59
  muddies
• 17:59
  the
• 17:59
  water.
• 18:00
  you
• 18:00
  don't
• 18:00
  know
• 18:01
  when
• 18:01
  your
• 18:01
  patient
• 18:01
  comes
• 18:02
  back
• 18:02
  if
• 18:02
  depression's
• 18:03
  getting
• 18:03
  worse.
• 18:03
  if
• 18:03
  they're
• 18:03
  in
• 18:04
  a,
• 18:04
  some
• 18:04
  sort
• 18:04
  of
• 18:04
  cannabis
• 18:05
  withdrawal.
• 18:05
  You
• 18:05
  don't
• 18:06
  know
• 18:06
  if
• 18:06
  you're
• 18:07
  looking
• 18:07
  at
• 18:07
  their
• 18:07
  depression
• 18:08
  getting
• 18:08
  naturally
• 18:09
  worse
• 18:09
  over
• 18:09
  time,
• 18:10
  or
• 18:10
  it's
• 18:10
  the
• 18:10
  cannabis
• 18:11
  use.
• 18:12
  worsening
• 18:12
  their
• 18:12
  depression
• 18:13
  over
• 18:13
  time,
• 18:14
  superimposed
• 18:15
  on
• 18:16
  that
• 18:16
  depression.
• 18:17
  It's
• 18:17
  very
• 18:17
  difficult
• 18:18
  to
• 18:19
  understand.
• 18:19
  Now,
• 18:20
  the
• 18:20
  good
• 18:20
  news
• 18:20
  is,
• 18:21
  rather
• 18:21
  than
• 18:21
  you
• 18:22
  having
• 18:22
  to
• 18:22
  be
• 18:22
  a
• 18:22
  detective
• 18:23
  all
• 18:23
  the
• 18:23
  time
• 18:23
  and
• 18:23
  figuring
• 18:24
  out
• 18:24
  the
• 18:24
  precise
• 18:24
  answer,
• 18:25
  because
• 18:25
  you
• 18:25
  can't
• 18:26
  always
• 18:26
  do
• 18:26
  that,
• 18:27
  there
• 18:27
  are
• 18:27
  clues.
• 18:28
  You
• 18:28
  can
• 18:29
  look
• 18:29
  at
• 18:29
  family
• 18:29
  history
• 18:30
  and
• 18:30
  say,
• 18:30
  okay,
• 18:31
  Benny's
• 18:31
  dad
• 18:31
  did
• 18:32
  have
• 18:32
  depression,
• 18:32
  so
• 18:32
  this
• 18:33
  is
• 18:33
  likely
• 18:34
  to
• 18:34
  be
• 18:34
  genetic
• 18:34
  component.
• 18:35
  his
• 18:35
  mom
• 18:36
  had
• 18:36
  anxiety.
• 18:37
  A
• 18:37
  lot
• 18:37
  of
• 18:37
  those
• 18:38
  brain
• 18:38
  circuits
• 18:38
  share
• 18:39
  real
• 18:39
  estate
• 18:40
  up
• 18:40
  there
• 18:40
  in
• 18:40
  the
• 18:40
  brain.
• 18:41
  a
• 18:41
  lot
• 18:41
  of
• 18:41
  those
• 18:41
  neural
• 18:41
  circuits
• 18:42
  are
• 18:43
  interconnected.
• 18:44
  There's
• 18:44
  probably
• 18:44
  a
• 18:45
  genetic
• 18:45
  predisposition
• 18:46
  to
• 18:46
  some
• 18:46
  kind
• 18:46
  of
• 18:46
  mental
• 18:47
  illness,
• 18:48
  and
• 18:48
  so
• 18:48
  this
• 18:48
  cannabis
• 18:49
  use
• 18:49
  this
• 18:49
  depression.
• 18:51
  It's
• 18:51
  not
• 18:51
  really
• 18:51
  out
• 18:52
  of
• 18:52
  the
• 18:52
  blue,
• 18:52
  either
• 18:53
  way
• 18:53
  we
• 18:53
  just
• 18:53
  have
• 18:53
  to
• 18:53
  treat
• 18:54
  this
• 18:54
  no
• 18:54
  matter
• 18:54
  what
• 18:55
  for
• 18:55
  what
• 18:55
  it
• 18:55
  is.
• 18:56
  Now,
• 18:56
  with
• 18:56
  younger
• 18:57
  people,
• 18:57
  especially,
• 18:58
  teens,
• 18:58
  young
• 18:59
  adults,
• 18:59
  motivational
• 19:00
  interviewing
• 19:00
  is
• 19:00
  especially
• 19:01
  important.
• 19:02
  not
• 19:02
  only
• 19:02
  might
• 19:02
  they
• 19:03
  not
• 19:03
  be
• 19:03
  motivated
• 19:04
  to
• 19:04
  Stop
• 19:05
  smoking
• 19:05
  cannabis.
• 19:06
  They
• 19:06
  might
• 19:06
  feel
• 19:07
  like
• 19:07
  it's
• 19:07
  perfectly
• 19:08
  fine.
• 19:08
  It
• 19:09
  integrates
• 19:09
  them
• 19:10
  well
• 19:10
  in
• 19:10
  their
• 19:10
  social
• 19:10
  circles.
• 19:11
  It's
• 19:11
  hip,
• 19:11
  it's
• 19:11
  cool.
• 19:12
  you
• 19:12
  have
• 19:12
  to
• 19:12
  connect
• 19:13
  this.
• 19:13
  Oh,
• 19:13
  you
• 19:13
  love
• 19:14
  basketball.
• 19:15
  when
• 19:15
  was
• 19:15
  the
• 19:15
  last
• 19:15
  time
• 19:15
  you
• 19:15
  were
• 19:16
  able
• 19:16
  to
• 19:16
  really
• 19:16
  play
• 19:16
  basketball
• 19:17
  at
• 19:17
  the
• 19:17
  top
• 19:18
  of
• 19:18
  your.
• 19:18
  Boom.
• 19:19
  You
• 19:19
  know,
• 19:19
  that's
• 19:20
  a
• 19:20
  good
• 19:20
  question
• 19:20
  to
• 19:20
  ask,
• 19:21
  right?
• 19:21
  Because
• 19:22
  maybe
• 19:22
  he
• 19:22
  loves
• 19:22
  basketball
• 19:23
  and
• 19:23
  wants
• 19:23
  to
• 19:23
  be
• 19:24
  at
• 19:24
  the
• 19:24
  top
• 19:24
  of
• 19:24
  his
• 19:24
  game
• 19:25
  and
• 19:25
  get
• 19:25
  back
• 19:25
  out
• 19:26
  there
• 19:26
  in
• 19:26
  a
• 19:26
  rec
• 19:26
  league
• 19:26
  or
• 19:27
  something.
• 19:27
  And
• 19:27
  then
• 19:28
  you
• 19:28
  connect
• 19:29
  the
• 19:29
  dots
• 19:29
  between
• 19:30
  him
• 19:30
  feeling
• 19:30
  sluggish
• 19:31
  when
• 19:31
  he
• 19:31
  is
• 19:32
  using
• 19:32
  cannabis
• 19:33
  and
• 19:33
  his
• 19:34
  basketball
• 19:34
  use.
• 19:35
  And
• 19:35
  now
• 19:36
  for
• 19:36
  the
• 19:36
  first
• 19:36
  time,
• 19:36
  he
• 19:37
  is
• 19:37
  really
• 19:37
  putting
• 19:37
  them
• 19:37
  together
• 19:38
  and
• 19:38
  going,
• 19:38
  oh
• 19:38
  yeah,
• 19:39
  that
• 19:39
  is
• 19:39
  really
• 19:39
  in
• 19:39
  my
• 19:40
  way,
• 19:40
  right?
• 19:41
  Because
• 19:41
  you're
• 19:41
  not
• 19:41
  gonna
• 19:41
  get
• 19:42
  a
• 19:42
  young
• 19:42
  guy
• 19:42
  to
• 19:43
  stop
• 19:43
  smoking
• 19:43
  cannabis
• 19:44
  just
• 19:44
  by
• 19:45
  showing
• 19:45
  him
• 19:45
  a
• 19:45
  bunch
• 19:46
  of
• 19:46
  evidence-based.
• 19:47
  you've
• 19:48
  got
• 19:48
  to
• 19:48
  connect
• 19:49
  what
• 19:49
  they
• 19:49
  love
• 19:49
  and
• 19:49
  what
• 19:50
  they're
• 19:50
  good
• 19:50
  at.
• 19:50
  Oh,
• 19:50
  your
• 19:50
  relationships.
• 19:51
  You
• 19:52
  mentioned
• 19:52
  your
• 19:52
  last
• 19:52
  three
• 19:53
  relationships
• 19:53
  have
• 19:53
  been
• 19:53
  really
• 19:54
  difficult.
• 19:54
  What
• 19:54
  are
• 19:54
  some
• 19:55
  of
• 19:55
  the
• 19:55
  reasons
• 19:55
  you
• 19:55
  feel
• 19:56
  like
• 19:56
  those
• 19:57
  relationships
• 19:57
  didn't
• 19:58
  work
• 19:58
  out?
• 19:58
  Oh,
• 19:59
  well,
• 19:59
  my
• 19:59
  girlfriend
• 20:00
  said
• 20:00
  that
• 20:01
  I'm
• 20:01
  just
• 20:01
  kind
• 20:01
  of
• 20:01
  a
• 20:01
  bore.
• 20:02
  I
• 20:02
  sit
• 20:02
  around
• 20:02
  and
• 20:03
  play
• 20:03
  video
• 20:03
  games
• 20:03
  a
• 20:03
  lot,
• 20:04
  and
• 20:04
  she
• 20:04
  hates
• 20:04
  that
• 20:04
  about
• 20:05
  me.
• 20:05
  And
• 20:06
  she
• 20:06
  said,
• 20:06
  my
• 20:06
  mood
• 20:06
  is
• 20:07
  always
• 20:07
  down.
• 20:07
  that's
• 20:08
  interesting
• 20:08
  because
• 20:08
  there
• 20:09
  is
• 20:09
  a
• 20:09
  lot
• 20:09
  of
• 20:09
  evidence
• 20:09
  that
• 20:10
  cannabis
• 20:10
  can
• 20:10
  worsen
• 20:11
  depression
• 20:11
  and
• 20:11
  alter
• 20:12
  dopamine
• 20:12
  signaling,
• 20:14
  which
• 20:15
  can
• 20:15
  make
• 20:15
  it
• 20:15
  harder
• 20:15
  to
• 20:15
  enjoy
• 20:16
  stuff
• 20:16
  like
• 20:16
  basketball
• 20:17
  and
• 20:17
  going
• 20:17
  out
• 20:18
  to
• 20:18
  eat
• 20:18
  with
• 20:18
  her
• 20:19
  and
• 20:19
  doing
• 20:19
  the
• 20:19
  stuff
• 20:19
  she
• 20:20
  wanted
• 20:20
  to
• 20:20
  do
• 20:20
  with
• 20:21
  you.
• 20:21
  I
• 20:21
  just
• 20:21
  wanted
• 20:22
  to
• 20:22
  connect
• 20:22
  those
• 20:22
  dots,
• 20:23
  Benny,
• 20:23
  because
• 20:24
  in
• 20:24
  the
• 20:24
  future
• 20:25
  you
• 20:25
  connecting
• 20:26
  cannabis
• 20:26
  use
• 20:27
  to
• 20:27
  your
• 20:27
  relationships
• 20:28
  might
• 20:28
  empower
• 20:28
  you
• 20:29
  to.
• 20:30
  Improve
• 20:31
  both
• 20:31
  things
• 20:31
  at
• 20:31
  once,
• 20:32
  that's
• 20:32
  why
• 20:32
  you
• 20:32
  really
• 20:33
  do
• 20:33
  want
• 20:34
  a
• 20:34
  good
• 20:34
  social
• 20:34
  history,
• 20:35
  right?
• 20:35
  Some
• 20:35
  people
• 20:35
  might
• 20:35
  blow
• 20:36
  off
• 20:36
  the
• 20:36
  social
• 20:36
  history.
• 20:37
  It
• 20:37
  should
• 20:37
  never
• 20:37
  blow
• 20:37
  off
• 20:38
  the
• 20:38
  social
• 20:38
  history.
• 20:39
  The
• 20:39
  social
• 20:39
  history
• 20:40
  is
• 20:40
  really
• 20:41
  ripe.
• 20:41
  It's
• 20:41
  your
• 20:41
  patient's
• 20:42
  story.
• 20:42
  And
• 20:42
  with
• 20:43
  that
• 20:43
  story,
• 20:44
  you
• 20:44
  have
• 20:44
  really
• 20:44
  good
• 20:45
  leverage
• 20:46
  points
• 20:46
  to
• 20:47
  bring
• 20:47
  this
• 20:47
  all
• 20:47
  in,
• 20:47
  to
• 20:48
  engage
• 20:48
  in
• 20:48
  motivational
• 20:49
  interviewing
• 20:50
  and
• 20:50
  to
• 20:50
  start
• 20:50
  generating
• 20:51
  a
• 20:51
  treatment
• 20:51
  plan.
• 20:52
  We're
• 20:52
  getting
• 20:53
  an
• 20:53
  idea
• 20:53
  that
• 20:54
  depression
• 20:54
  came
• 20:54
  first,
• 20:55
  then
• 20:55
  came
• 20:55
  cannabis.
• 20:56
  He
• 20:56
  doesn't
• 20:56
  know
• 20:56
  the
• 20:56
  THC
• 20:57
  potency.
• 20:58
  We're
• 20:58
  educating
• 20:58
  him
• 20:58
  around
• 20:59
  along
• 20:59
  the
• 20:59
  way
• 21:00
  to
• 21:00
  just
• 21:00
  sprinkle
• 21:01
  some
• 21:01
  stuff
• 21:01
  there.
• 21:02
  Again,
• 21:02
  education's
• 21:03
  not
• 21:03
  gonna
• 21:03
  be
• 21:03
  the
• 21:03
  full
• 21:04
  shebang,
• 21:05
  but
• 21:05
  we're
• 21:05
  trying
• 21:06
  to
• 21:06
  connect
• 21:06
  the
• 21:06
  dots
• 21:07
  for
• 21:07
  him
• 21:07
  so
• 21:08
  that
• 21:08
  he
• 21:08
  understands
• 21:09
  the
• 21:09
  context
• 21:10
  of
• 21:10
  his
• 21:10
  use
• 21:11
  and
• 21:11
  how
• 21:11
  it
• 21:11
  might
• 21:11
  be
• 21:11
  worsening.
• 21:12
  Things
• 21:13
  you
• 21:13
  do,
• 21:13
  your
• 21:13
  whole
• 21:14
  DSM
• 21:15
  five.
• 21:16
  write
• 21:16
  up
• 21:16
  or
• 21:17
  you
• 21:17
  use
• 21:18
  your
• 21:18
  DSM
• 21:18
  five
• 21:19
  to
• 21:19
  understand
• 21:19
  what's
• 21:19
  going
• 21:20
  on.
• 21:21
  he's
• 21:21
  depressed
• 21:21
  most
• 21:22
  of
• 21:22
  the
• 21:22
  day.
• 21:22
  Nearly
• 21:23
  every
• 21:23
  day
• 21:24
  is
• 21:24
  what
• 21:24
  he's
• 21:24
  telling
• 21:25
  you.
• 21:26
  Diminished
• 21:26
  interest
• 21:27
  or
• 21:27
  pleasure
• 21:27
  in
• 21:27
  doing
• 21:28
  things
• 21:28
  those
• 21:29
  are
• 21:29
  two
• 21:29
  extremely
• 21:30
  important
• 21:30
  criteria
• 21:31
  Major
• 21:31
  depressive
• 21:32
  episode.
• 21:33
  He's
• 21:33
  got
• 21:33
  weight
• 21:33
  gain.
• 21:34
  He's
• 21:34
  oversleeping.
• 21:35
  He's
• 21:35
  fatigued,
• 21:36
  so
• 21:36
  he
• 21:36
  meets
• 21:37
  criteria,
• 21:37
  Five
• 21:38
  of
• 21:38
  the
• 21:38
  nine
• 21:38
  criteria
• 21:39
  that
• 21:39
  you
• 21:39
  need,
• 21:40
  but
• 21:40
  there's
• 21:40
  also
• 21:41
  cannabis
• 21:41
  use
• 21:41
  disorder.
• 21:42
  you
• 21:42
  may
• 21:42
  not
• 21:42
  have
• 21:43
  time
• 21:43
  in
• 21:44
  60
• 21:44
  minutes
• 21:44
  or
• 21:44
  however
• 21:45
  long
• 21:45
  your
• 21:46
  company's
• 21:46
  gonna
• 21:47
  give
• 21:47
  you
• 21:48
  to
• 21:49
  flesh
• 21:49
  out
• 21:49
  a
• 21:49
  full
• 21:49
  diagnosis,
• 21:50
  and
• 21:50
  that's
• 21:50
  okay.
• 21:51
  You
• 21:51
  just
• 21:51
  wanna
• 21:51
  orient
• 21:52
  yourself
• 21:53
  to
• 21:53
  the
• 21:54
  chief.
• 21:55
  Potential
• 21:55
  or
• 21:56
  differential
• 21:56
  diagnoses.
• 21:57
  So
• 21:57
  you
• 21:57
  can
• 21:57
  start
• 21:58
  formulating
• 21:58
  a
• 21:58
  treatment
• 21:59
  plan.
• 21:59
  Take
• 21:59
  your
• 21:59
  time.
• 22:00
  If
• 22:00
  it's
• 22:00
  in
• 22:01
  the
• 22:01
  outpatient
• 22:01
  space,
• 22:02
  it's
• 22:02
  not
• 22:02
  an
• 22:02
  emergency
• 22:03
  or
• 22:03
  else
• 22:03
  they'd
• 22:03
  be
• 22:04
  in
• 22:04
  the
• 22:04
  er.
• 22:05
  So
• 22:05
  don't
• 22:05
  put
• 22:05
  undue
• 22:06
  pressure
• 22:06
  on
• 22:06
  yourself
• 22:07
  at
• 22:07
  the
• 22:07
  same
• 22:07
  time,
• 22:08
  try
• 22:08
  to
• 22:08
  get
• 22:09
  this
• 22:09
  right,
• 22:09
  try
• 22:10
  to
• 22:10
  do
• 22:10
  your
• 22:10
  best,
• 22:11
  and
• 22:11
  we're
• 22:11
  definitely
• 22:12
  contending
• 22:12
  with
• 22:12
  two
• 22:12
  potential.
• 22:14
  Diagnoses
• 22:14
  here.
• 22:15
  when
• 22:15
  it
• 22:15
  comes
• 22:15
  to
• 22:15
  cannabis
• 22:16
  disorder,
• 22:16
  you
• 22:16
  can
• 22:16
  really
• 22:17
  flesh
• 22:17
  out
• 22:17
  how
• 22:18
  pervasive
• 22:18
  is
• 22:19
  this.
• 22:19
  you
• 22:19
  whip
• 22:19
  out
• 22:19
  the
• 22:19
  cannabis
• 22:20
  use
• 22:20
  disorder,
• 22:21
  DSM
• 22:22
  diagnostics
• 22:23
  to
• 22:23
  really
• 22:24
  understand
• 22:24
  that.
• 22:24
  is
• 22:25
  your
• 22:25
  cannabis
• 22:25
  use
• 22:25
  going
• 22:26
  up
• 22:26
  with
• 22:26
  time?
• 22:26
  Have
• 22:27
  you
• 22:27
  tried
• 22:27
  to
• 22:27
  cut
• 22:27
  back
• 22:28
  multiple
• 22:28
  times?
• 22:29
  How
• 22:29
  much
• 22:29
  time
• 22:29
  do
• 22:29
  you
• 22:30
  spend
• 22:30
  trying
• 22:31
  to
• 22:31
  obtain
• 22:31
  cannabis
• 22:32
  or
• 22:32
  use
• 22:32
  it
• 22:32
  or
• 22:32
  recover
• 22:33
  from
• 22:33
  its
• 22:33
  effects?
• 22:34
  Do
• 22:34
  you
• 22:34
  crave
• 22:34
  it?
• 22:35
  are
• 22:35
  you
• 22:35
  using
• 22:36
  this?
• 22:36
  And
• 22:36
  even
• 22:37
  though
• 22:37
  it's.
• 22:38
  Harder
• 22:39
  and
• 22:39
  harder
• 22:39
  for
• 22:39
  you
• 22:39
  to
• 22:40
  do
• 22:40
  your
• 22:40
  job.
• 22:41
  You
• 22:41
  know,
• 22:41
  Benny,
• 22:41
  I
• 22:42
  think
• 22:42
  I
• 22:42
  mentioned
• 22:42
  he's
• 22:42
  an
• 22:42
  HR
• 22:43
  rep.
• 22:43
  if
• 22:43
  you
• 22:43
  keep
• 22:43
  getting
• 22:44
  fired
• 22:44
  from
• 22:44
  HR
• 22:45
  rep
• 22:45
  jobs
• 22:46
  because
• 22:46
  you
• 22:46
  come
• 22:46
  in
• 22:47
  late
• 22:47
  and
• 22:47
  you
• 22:47
  fall
• 22:47
  asleep
• 22:48
  at
• 22:48
  your
• 22:48
  desk,
• 22:49
  but
• 22:49
  you
• 22:49
  keep
• 22:49
  using
• 22:49
  cannabis
• 22:50
  anyway,
• 22:50
  knowing
• 22:51
  that
• 22:51
  cannabis
• 22:51
  makes
• 22:52
  you
• 22:52
  fall
• 22:52
  asleep
• 22:52
  at
• 22:52
  your
• 22:52
  desk,
• 22:53
  right?
• 22:53
  We're
• 22:54
  really
• 22:54
  going
• 22:54
  down
• 22:54
  the
• 22:54
  cannabis
• 22:55
  use
• 22:55
  disorder
• 22:56
  pathway,
• 22:56
  so
• 22:56
  I
• 22:56
  would
• 22:57
  highly
• 22:58
  recommend
• 22:59
  that
• 22:59
  you
• 23:00
  whip
• 23:00
  out
• 23:00
  the
• 23:00
  DSM
• 23:01
  With
• 23:01
  time,
• 23:01
  a
• 23:02
  lot
• 23:02
  of
• 23:02
  the
• 23:03
  DSM
• 23:04
  five
• 23:04
  TR
• 23:05
  diagnostics
• 23:06
  are
• 23:06
  gonna
• 23:06
  become
• 23:07
  more
• 23:07
  natural
• 23:08
  to
• 23:08
  you
• 23:09
  and
• 23:09
  you're
• 23:09
  not
• 23:09
  gonna
• 23:09
  have
• 23:10
  to
• 23:10
  whip
• 23:10
  out
• 23:10
  the
• 23:10
  textbook
• 23:11
  each
• 23:11
  time.
• 23:11
  I
• 23:12
  have
• 23:12
  had
• 23:12
  to
• 23:12
  whip
• 23:12
  out
• 23:12
  the
• 23:13
  DSM
• 23:13
  five
• 23:13
  TR
• 23:14
  a
• 23:14
  few
• 23:14
  times.
• 23:15
  I
• 23:15
  might
• 23:16
  whip
• 23:16
  it
• 23:16
  out
• 23:16
  in
• 23:17
  session
• 23:18
  and
• 23:19
  I've
• 23:19
  never
• 23:20
  had
• 23:20
  a
• 23:20
  patient
• 23:20
  judge
• 23:21
  me
• 23:21
  for
• 23:21
  that.
• 23:22
  In
• 23:22
  fact,
• 23:22
  it
• 23:23
  conveys
• 23:23
  that
• 23:24
  you
• 23:24
  are
• 23:24
  quite
• 23:24
  thorough
• 23:25
  and
• 23:25
  that
• 23:25
  you
• 23:25
  care,
• 23:26
  and
• 23:26
  sometimes
• 23:26
  they
• 23:27
  really
• 23:27
  enjoy.
• 23:28
  And
• 23:29
  being
• 23:29
  able
• 23:29
  to
• 23:30
  resonate
• 23:30
  with
• 23:30
  these
• 23:30
  diagnoses,
• 23:31
  it
• 23:31
  gives
• 23:31
  them
• 23:32
  a
• 23:32
  sense
• 23:32
  of
• 23:32
  control.
• 23:33
  the
• 23:33
  word
• 23:34
  on
• 23:34
  the
• 23:34
  street
• 23:34
  is
• 23:34
  that
• 23:35
  patients
• 23:35
  hate
• 23:35
  diagnoses
• 23:36
  and
• 23:36
  their
• 23:36
  stigmas
• 23:37
  and
• 23:37
  you
• 23:37
  have
• 23:37
  to
• 23:37
  be
• 23:38
  careful.
• 23:38
  You
• 23:38
  have
• 23:38
  to
• 23:39
  tread
• 23:39
  lightly
• 23:40
  with
• 23:40
  how
• 23:40
  you
• 23:40
  approach
• 23:41
  this.
• 23:41
  you
• 23:42
  don't
• 23:42
  wanna
• 23:42
  just
• 23:42
  walk
• 23:42
  up
• 23:42
  to
• 23:43
  one
• 23:43
  of
• 23:43
  your
• 23:43
  patients
• 23:43
  and
• 23:43
  say,
• 23:44
  Hey,
• 23:44
  you
• 23:44
  have
• 23:45
  bipolar
• 23:45
  one.
• 23:45
  Congratulations.
• 23:46
  You
• 23:47
  want
• 23:47
  to.
• 23:48
  Really
• 23:49
  approach
• 23:49
  this
• 23:50
  and
• 23:50
  get
• 23:50
  a
• 23:50
  sense
• 23:51
  for
• 23:51
  your
• 23:51
  patient.
• 23:51
  'cause
• 23:51
  some
• 23:51
  of
• 23:51
  your
• 23:52
  patients
• 23:52
  are
• 23:52
  so
• 23:52
  lost
• 23:53
  and
• 23:53
  they're
• 23:53
  so
• 23:53
  scared
• 23:54
  and
• 23:54
  they
• 23:54
  don't
• 23:54
  know
• 23:54
  what's
• 23:55
  going
• 23:55
  on
• 23:55
  with
• 23:55
  them,
• 23:56
  and
• 23:56
  they
• 23:56
  feel
• 23:56
  a
• 23:56
  huge
• 23:57
  sense
• 23:57
  of
• 23:57
  relief
• 23:58
  when
• 23:58
  you
• 23:58
  share
• 23:59
  that
• 23:59
  this
• 23:59
  is
• 23:59
  something
• 24:00
  that
• 24:00
  is
• 24:00
  known.
• 24:00
  It
• 24:01
  is
• 24:01
  manageable,
• 24:01
  it
• 24:01
  is
• 24:02
  treatable.
• 24:02
  we
• 24:03
  know
• 24:03
  the
• 24:03
  contours
• 24:03
  of
• 24:04
  this
• 24:04
  at
• 24:04
  least.
• 24:05
  you
• 24:05
  don't
• 24:05
  wanna
• 24:05
  over
• 24:05
  promise
• 24:06
  and
• 24:06
  say
• 24:06
  they're
• 24:06
  never
• 24:07
  gonna
• 24:07
  be
• 24:07
  depressed
• 24:07
  again.
• 24:08
  But
• 24:08
  giving
• 24:09
  them
• 24:09
  a
• 24:09
  sense
• 24:09
  of
• 24:09
  control
• 24:10
  and
• 24:10
  structure
• 24:10
  can
• 24:10
  be
• 24:11
  very
• 24:11
  empowering
• 24:12
  We
• 24:13
  talked
• 24:13
  about
• 24:13
  Wellbutrin,
• 24:14
  and
• 24:15
  Wellbutrin
• 24:16
  is
• 24:16
  uniquely
• 24:17
  suitable
• 24:17
  for
• 24:17
  Benny
• 24:18
  because
• 24:18
  it's
• 24:18
  a
• 24:18
  norepinephrine
• 24:19
  dopamine
• 24:20
  reuptake
• 24:20
  inhibitor.
• 24:21
  It's
• 24:21
  really
• 24:21
  good
• 24:22
  when
• 24:22
  you're
• 24:22
  not
• 24:22
  getting
• 24:22
  pleasure
• 24:23
  out
• 24:23
  of
• 24:23
  your
• 24:23
  everyday
• 24:24
  life,
• 24:25
  when
• 24:25
  you're
• 24:25
  fatigued,
• 24:26
  when
• 24:26
  you're
• 24:26
  sleeping
• 24:27
  too
• 24:27
  much.
• 24:28
  You
• 24:28
  have
• 24:28
  low
• 24:28
  motivation.
• 24:29
  It
• 24:29
  also
• 24:30
  doesn't
• 24:30
  have
• 24:30
  sexual
• 24:31
  side
• 24:31
  effects
• 24:31
  for
• 24:31
  the
• 24:32
  most
• 24:32
  part.
• 24:32
  you
• 24:32
  might
• 24:32
  have
• 24:33
  some
• 24:33
  random
• 24:34
  patient
• 24:34
  who
• 24:34
  does
• 24:34
  but
• 24:35
  by
• 24:35
  and
• 24:35
  large
• 24:35
  it
• 24:35
  does
• 24:36
  not
• 24:36
  do
• 24:36
  that.
• 24:37
  And
• 24:37
  it's
• 24:37
  pretty
• 24:38
  weight
• 24:38
  neutral.
• 24:39
  Some
• 24:39
  will
• 24:39
  even
• 24:39
  lose
• 24:40
  weight
• 24:40
  on
• 24:40
  Wellbutrin,
• 24:41
  but
• 24:41
  it's
• 24:42
  tends
• 24:42
  to
• 24:42
  be
• 24:42
  weight
• 24:42
  neutral.
• 24:43
  And
• 24:44
  so
• 24:44
  for
• 24:44
  Benny,
• 24:45
  this
• 24:45
  is
• 24:45
  a
• 24:45
  really
• 24:45
  good
• 24:46
  candidate,
• 24:46
  right?
• 24:47
  We've
• 24:47
  ruled
• 24:47
  out
• 24:48
  seizures.
• 24:49
  He
• 24:49
  hasn't
• 24:49
  had
• 24:49
  any
• 24:49
  history
• 24:50
  of
• 24:50
  eating
• 24:50
  disorders.
• 24:51
  He's
• 24:51
  tried
• 24:51
  an
• 24:51
  SSRI.
• 24:53
  He
• 24:53
  doesn't
• 24:54
  have
• 24:54
  anxiety
• 24:54
  either.
• 24:55
  He's
• 24:55
  really
• 24:55
  telling
• 24:55
  you
• 24:56
  it's
• 24:56
  mostly
• 24:56
  depression,
• 24:57
  and
• 24:57
  sometimes
• 24:58
  Wellbutrin
• 24:58
  can
• 24:58
  make
• 24:58
  people
• 24:59
  a
• 24:59
  little
• 24:59
  more
• 24:59
  anxious,
• 25:00
  so
• 25:00
  it's
• 25:00
  good
• 25:00
  he
• 25:00
  doesn't
• 25:01
  gravitate
• 25:02
  towards
• 25:02
  the
• 25:02
  anxious
• 25:02
  side.
• 25:04
  Like
• 25:04
  everything
• 25:04
  else
• 25:05
  in
• 25:05
  Psychopharm
• 25:05
  folks,
• 25:06
  it's
• 25:06
  not
• 25:06
  as
• 25:06
  simple
• 25:07
  as
• 25:07
  Wellbutrin
• 25:08
  always
• 25:08
  causes
• 25:09
  anxiety.
• 25:09
  Sometimes
• 25:10
  it
• 25:10
  doesn't.
• 25:11
  Sometimes
• 25:11
  it
• 25:11
  actually
• 25:11
  makes
• 25:12
  people
• 25:12
  less
• 25:12
  anxious.
• 25:13
  Wellbutrin
• 25:13
  is
• 25:13
  good
• 25:14
  because
• 25:14
  dopamine
• 25:15
  motivates
• 25:15
  somebody
• 25:16
  to
• 25:16
  get
• 25:16
  up
• 25:17
  and
• 25:17
  do
• 25:17
  something.
• 25:17
  Things
• 25:18
  that
• 25:18
  were
• 25:18
  otherwise
• 25:18
  not
• 25:19
  as
• 25:19
  enjoyable,
• 25:19
  become
• 25:20
  more
• 25:20
  enjoyable.
• 25:21
  The
• 25:21
  anticipation.
• 25:23
  To
• 25:23
  do
• 25:23
  something
• 25:24
  usually
• 25:25
  involves
• 25:26
  more
• 25:26
  joy
• 25:26
  when
• 25:27
  dopamine
• 25:27
  is
• 25:27
  boosted,
• 25:28
  and
• 25:29
  so
• 25:30
  that's
• 25:30
  really
• 25:31
  a
• 25:31
  key
• 25:31
  neurotransmitter
• 25:32
  to
• 25:32
  target
• 25:32
  for
• 25:32
  Benny
• 25:33
  in
• 25:33
  particular.
• 25:34
  And
• 25:34
  norepinephrine
• 25:35
  is
• 25:36
  a
• 25:37
  neurotransmitter
• 25:37
  that
• 25:38
  allows
• 25:38
  you
• 25:38
  to
• 25:38
  be
• 25:38
  more
• 25:38
  alert
• 25:39
  and
• 25:40
  focused.
• 25:40
  He
• 25:40
  told
• 25:40
  you
• 25:40
  he
• 25:41
  had
• 25:41
  concentrational
• 25:42
  deficits,
• 25:42
  so
• 25:43
  this
• 25:43
  is
• 25:43
  a
• 25:43
  unique
• 25:44
  medication
• 25:45
  for
• 25:46
  his
• 25:46
  unique.
• 25:48
  Presentation,
• 25:48
  and
• 25:49
  that's
• 25:49
  really
• 25:49
  your
• 25:49
  goal,
• 25:50
  right?
• 25:50
  You're
• 25:50
  almost
• 25:50
  like
• 25:50
  a
• 25:50
  tailor
• 25:51
  when
• 25:51
  you're
• 25:51
  getting
• 25:51
  a
• 25:51
  suit
• 25:52
  tailored
• 25:52
  or
• 25:53
  for
• 25:53
  the
• 25:53
  ladies
• 25:53
  out
• 25:54
  there
• 25:54
  when
• 25:54
  you
• 25:54
  get
• 25:55
  a
• 25:55
  dress
• 25:55
  tailored
• 25:55
  When
• 25:56
  it
• 25:56
  comes
• 25:56
  to
• 25:56
  your
• 25:57
  own
• 25:57
  dresses,
• 25:58
  do
• 25:58
  you
• 25:58
  tailor
• 25:58
  them?
• 25:59
  So
• 25:59
  Wellbutrin,
• 26:00
  right?
• 26:01
  This
• 26:01
  might
• 26:01
  be
• 26:02
  the
• 26:02
  best
• 26:02
  thing
• 26:03
  for
• 26:04
  Benny
• 26:06
  Norepinephrine
• 26:06
  and
• 26:07
  dopamine
• 26:07
  reuptake
• 26:08
  inhibitor.
• 26:10
  Start
• 26:10
  'em
• 26:10
  at
• 26:10
  150
• 26:11
  milligrams
• 26:12
  xl.
• 26:13
  Give
• 26:13
  it
• 26:13
  a
• 26:13
  few
• 26:14
  days,
• 26:14
  maybe
• 26:14
  four
• 26:15
  or
• 26:15
  five
• 26:15
  days.
• 26:15
  It
• 26:16
  can
• 26:16
  take
• 26:16
  up
• 26:16
  to
• 26:16
  a
• 26:16
  week.
• 26:17
  Go
• 26:17
  up
• 26:17
  to
• 26:17
  300
• 26:18
  milligrams.
• 26:18
  Excel
• 26:19
  as
• 26:19
  tolerated
• 26:20
  to
• 26:20
  see
• 26:20
  how
• 26:20
  he's
• 26:20
  doing,
• 26:21
  right?
• 26:22
  And
• 26:23
  you
• 26:23
  want
• 26:24
  to
• 26:24
  really.
• 26:25
  Continue
• 26:26
  to
• 26:26
  utilize
• 26:27
  motivational
• 26:27
  interviewing
• 26:28
  and
• 26:29
  empower
• 26:29
  him
• 26:29
  to
• 26:29
  curtail
• 26:30
  his
• 26:30
  cannabis
• 26:30
  use.
• 26:31
  it's
• 26:31
  going
• 26:31
  to
• 26:31
  give
• 26:31
  you
• 26:31
  more
• 26:32
  diagnostic
• 26:32
  clarity.
• 26:33
  It's
• 26:33
  going
• 26:33
  to
• 26:33
  further
• 26:34
  potentially
• 26:35
  alleviate
• 26:35
  his
• 26:35
  depressive
• 26:36
  symptoms,
• 26:37
  et
• 26:37
  cetera,
• 26:38
  et
• 26:38
  cetera.
• 26:39
  So
• 26:40
  I
• 26:40
  hope
• 26:40
  you
• 26:40
  enjoyed
• 26:41
  this
• 26:41
  deep
• 26:41
  dive
• 26:41
  here.
• 26:43
  This
• 26:44
  mock
• 26:44
  case
• 26:44
  study
• 26:45
  with
• 26:45
  beanbag
• 26:45
  Benny.
• 26:46
  Turns
• 26:46
  out
• 26:46
  we
• 26:46
  put
• 26:47
  him
• 26:47
  on
• 26:47
  Wellbutrin.
• 26:47
  His
• 26:47
  depression
• 26:48
  symptoms
• 26:49
  were
• 26:49
  alleviated.
• 26:50
  He
• 26:50
  stopped
• 26:50
  using
• 26:51
  cannabis
• 26:51
  as
• 26:51
  much,
• 26:52
  but
• 26:52
  he
• 26:52
  still
• 26:52
  used
• 26:52
  it
• 26:52
  a
• 26:52
  little
• 26:53
  bit.
• 26:53
  We
• 26:53
  sent
• 26:54
  him
• 26:54
  to
• 26:54
  psychotherapy
• 26:55
  to
• 26:55
  gain
• 26:55
  more
• 26:55
  insight
• 26:56
  into
• 26:56
  why
• 26:57
  he
• 26:57
  uses
• 26:58
  cannabis,
• 26:58
  to
• 26:58
  investigate
• 26:59
  if
• 26:59
  there's
• 26:59
  anything
• 27:00
  in
• 27:00
  his
• 27:00
  past
• 27:01
  that
• 27:01
  contributes
• 27:01
  to
• 27:02
  his
• 27:02
  depressive
• 27:03
  outlook
• 27:04
  and
• 27:04
  to
• 27:04
  understand
• 27:05
  his
• 27:06
  life
• 27:06
  accordingly.
• 27:07
  Benny
• 27:08
  came
• 27:08
  back
• 27:09
  four
• 27:09
  weeks
• 27:09
  later.
• 27:10
  He
• 27:10
  had
• 27:10
  a
• 27:10
  little
• 27:10
  dry
• 27:11
  mouth
• 27:11
  and
• 27:11
  headaches
• 27:11
  from
• 27:12
  Wellbutrin,
• 27:12
  but
• 27:12
  it
• 27:12
  resolved
• 27:13
  on
• 27:13
  its
• 27:13
  own.
• 27:13
  He
• 27:13
  hydrated
• 27:14
  pretty
• 27:14
  well.
• 27:15
  He
• 27:16
  feels
• 27:16
  pretty
• 27:17
  good.
• 27:17
  He
• 27:17
  wants
• 27:17
  to
• 27:17
  stay
• 27:18
  on
• 27:18
  the
• 27:18
  300
• 27:18
  milligrams
• 27:19
  XL
• 27:19
  at
• 27:19
  this
• 27:20
  point,
• 27:20
  and
• 27:21
  his
• 27:21
  cannabis
• 27:21
  use
• 27:21
  has
• 27:22
  gone
• 27:22
  down.
• 27:22
  He
• 27:22
  is
• 27:22
  being
• 27:22
  more
• 27:23
  mindful
• 27:23
  of
• 27:23
  the
• 27:23
  THC
• 27:24
  potency
• 27:25
  in
• 27:25
  his
• 27:25
  cannabis,
• 27:25
  and
• 27:26
  he
• 27:26
  is
• 27:26
  trying
• 27:26
  to
• 27:26
  get
• 27:26
  back
• 27:26
  on
• 27:27
  the
• 27:27
  basketball
• 27:27
  court.
• 27:28
  All
• 27:28
  things
• 27:29
  going
• 27:30
  pretty
• 27:30
  well.
• 27:32
  So
• 27:32
  I
• 27:32
  do
• 27:32
  wanna
• 27:32
  remind
• 27:33
  all
• 27:33
  of
• 27:33
  you
• 27:33
  in
• 27:33
  practice,
• 27:34
  of
• 27:35
  course
• 27:35
  there
• 27:35
  might
• 27:36
  be
• 27:36
  more
• 27:36
  curve
• 27:36
  balls.
• 27:37
  every
• 27:37
  patient
• 27:37
  is
• 27:37
  a
• 27:37
  little
• 27:38
  bit
• 27:38
  different.
• 27:39
  it's
• 27:39
  very
• 27:39
  important
• 27:39
  for
• 27:40
  you
• 27:40
  to
• 27:40
  always
• 27:40
  consult
• 27:41
  the
• 27:41
  evidence
• 27:41
  get
• 27:41
  with
• 27:42
  your
• 27:42
  collaborators
• 27:43
  and
• 27:44
  to
• 27:44
  never.
• 27:46
  Feel
• 27:46
  alone
• 27:46
  in
• 27:47
  your
• 27:47
  journey.
• 27:47
  It's
• 27:47
  all
• 27:48
  going
• 27:48
  to
• 27:48
  come
• 27:48
  together.
• 27:49
  my
• 27:50
  friends.
• 27:50
  That
• 27:50
  is
• 27:50
  about
• 27:51
  it
• 27:51
  for
• 27:51
  today's
• 27:52
  podcast.
• 27:53
  I
• 27:53
  really
• 27:53
  hope
• 27:53
  you
• 27:54
  enjoyed
• 27:54
  this,
• 27:55
  and
• 27:55
  if
• 27:56
  you
• 27:56
  are
• 27:56
  enjoying
• 27:57
  this
• 27:57
  podcast,
• 27:58
  I
• 27:58
  can't
• 27:58
  emphasize
• 27:59
  enough
• 27:59
  how
• 27:59
  important
• 28:00
  it
• 28:00
  is
• 28:01
  for
• 28:01
  you
• 28:01
  to
• 28:01
  become
• 28:01
  a
• 28:02
  Patreon
• 28:02
  member.
• 28:03
  This
• 28:03
  entire
• 28:04
  lecture
• 28:04
  is
• 28:04
  in
• 28:05
  the
• 28:05
  form
• 28:05
  of
• 28:05
  a
• 28:05
  beautiful
• 28:06
  slide
• 28:06
  deck,
• 28:07
  and
• 28:07
  every
• 28:07
  lecture
• 28:08
  is
• 28:08
  in
• 28:08
  the
• 28:08
  form
• 28:09
  of
• 28:09
  beautiful
• 28:09
  slide
• 28:10
  decks,
• 28:10
  chock-full
• 28:11
  of
• 28:12
  pearls,
• 28:12
  evidence-based
• 28:13
  practice.
• 28:14
  Fascinating
• 28:14
  research
• 28:15
  articles
• 28:16
  you
• 28:16
  can
• 28:16
  read
• 28:16
  on
• 28:17
  your
• 28:17
  next
• 28:17
  coffee
• 28:17
  break
• 28:19
  case
• 28:19
  studies
• 28:20
  that
• 28:20
  come
• 28:20
  in
• 28:20
  a
• 28:20
  private
• 28:21
  podcast
• 28:22
  feed
• 28:23
  for
• 28:23
  Patreon
• 28:23
  members.
• 28:24
  This
• 28:24
  is
• 28:25
  a
• 28:25
  must
• 28:25
  have
• 28:26
  for
• 28:26
  your
• 28:26
  clinical
• 28:26
  toolkit
• 28:27
  to
• 28:27
  boost
• 28:27
  your
• 28:27
  confidence
• 28:28
  and
• 28:28
  your
• 28:28
  impact.
• 28:30
  You
• 28:30
  will
• 28:30
  feel
• 28:30
  sharper,
• 28:31
  faster,
• 28:31
  and
• 28:32
  more
• 28:32
  prepared.
• 28:32
  Look
• 28:33
  at
• 28:33
  the
• 28:33
  show
• 28:33
  notes.
• 28:34
  Become
• 28:34
  a
• 28:34
  Patreon
• 28:34
  member,
• 28:35
  and
• 28:35
  please,
• 28:35
  if
• 28:35
  you
• 28:35
  can't
• 28:36
  do
• 28:36
  that,
• 28:36
  rate
• 28:37
  us
• 28:37
  on
• 28:38
  Apple.
• 28:39
  That
• 28:39
  is
• 28:39
  a
• 28:39
  huge
• 28:40
  way
• 28:40
  to
• 28:40
  move
• 28:40
  this
• 28:40
  podcast
• 28:41
  forward.
• 28:41
  It's
• 28:42
  already
• 28:42
  gaining
• 28:43
  a
• 28:43
  ton
• 28:43
  of
• 28:43
  traction
• 28:44
  among
• 28:44
  psych,
• 28:44
  NP
• 28:44
  students.
• 28:45
  Lots
• 28:46
  of
• 28:46
  sharing
• 28:46
  in
• 28:46
  communities.
• 28:47
  It's
• 28:47
  been
• 28:47
  really
• 28:47
  exciting.
• 28:48
  It's
• 28:48
  taken
• 28:48
  off
• 28:48
  much
• 28:49
  faster
• 28:49
  than
• 28:49
  we
• 28:49
  thought.
• 28:50
  Please
• 28:50
  share
• 28:51
  it
• 28:51
  with
• 28:51
  anyone
• 28:52
  who's
• 28:52
  becoming
• 28:52
  a
• 28:52
  psych
• 28:52
  NP
• 28:53
  and
• 28:53
  we're
• 28:54
  building
• 28:54
  a
• 28:54
  strong,
• 28:55
  fun
• 28:56
  community.
• 28:56
  One
• 28:57
  case
• 28:57
  study
• 28:58
  at
• 28:58
  a
• 28:58
  time.
• 28:59
  Signing
• 28:59
  off
• 28:59
  Dr.
• 29:00
  Z.
• 29:01
  It
• 29:01
  has
• 29:01
  been
• 29:01
  my
• 29:02
  pleasure
• 29:03
  to
• 29:03
  be
• 29:04
  with
• 29:04
  you
• 29:04
  here
• 29:04
  on
• 29:04
  another
• 29:05
  episode
• 29:05
  of
• 29:05
  Pearls
• 29:06
  and
• 29:07
  Prep.