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Catch the Curveball: Can you spot the problem in this mock medication regimen? · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:06
  back,
• 0:06
  my
• 0:06
  friends,
• 0:06
  to
• 0:07
  another
• 0:07
  episode
• 0:07
  of
• 0:08
  Pearls
• 0:09
  and
• 0:09
  Prep.
• 0:10
  Today
• 0:10
  we're
• 0:11
  going
• 0:11
  to
• 0:11
  talk
• 0:11
  about
• 0:12
  a
• 0:12
  mock
• 0:13
  patient
• 0:13
  named
• 0:14
  Larry.
• 0:15
  And
• 0:16
  this
• 0:16
  segment
• 0:17
  is
• 0:17
  called
• 0:18
  Catch
• 0:18
  the
• 0:18
  Curve
• 0:18
  Ball.
• 0:19
  I'm
• 0:19
  going
• 0:20
  to
• 0:20
  give
• 0:20
  you
• 0:20
  a
• 0:20
  one
• 0:21
  paragraph
• 0:21
  summary
• 0:22
  of
• 0:22
  this
• 0:23
  case
• 0:24
  and
• 0:24
  you're
• 0:24
  going
• 0:24
  to
• 0:24
  tell
• 0:25
  me
• 0:26
  what
• 0:26
  the
• 0:26
  curveball
• 0:27
  is
• 0:27
  here.
• 0:27
  What's
• 0:28
  this
• 0:28
  specific
• 0:28
  curveball?
• 0:29
  What
• 0:29
  is
• 0:30
  wrong
• 0:30
  with
• 0:30
  this
• 0:30
  picture
• 0:31
  that
• 0:31
  is
• 0:31
  causing
• 0:32
  this
• 0:32
  problem?
• 0:33
  And
• 0:33
  there
• 0:33
  will
• 0:33
  be
• 0:33
  one
• 0:34
  answer
• 0:34
  in
• 0:34
  particular
• 0:35
  that
• 0:35
  I
• 0:35
  want
• 0:36
  you
• 0:36
  to
• 0:36
  catch.
• 0:36
  Hence,
• 0:37
  catch
• 0:37
  the
• 0:37
  curveball.
• 0:38
  There's
• 0:38
  going
• 0:38
  to
• 0:38
  be
• 0:38
  one
• 0:39
  thing
• 0:39
  that
• 0:39
  if
• 0:40
  you
• 0:40
  identify
• 0:40
  it
• 0:40
  properly,
• 0:41
  you
• 0:41
  will
• 0:42
  understand
• 0:42
  what
• 0:42
  the
• 0:43
  problem
• 0:43
  is
• 0:43
  here.
• 0:43
  This
• 0:44
  is
• 0:44
  not
• 0:44
  meant
• 0:44
  to
• 0:45
  be
• 0:45
  a
• 0:45
  trick
• 0:45
  question.
• 0:46
  This
• 0:46
  is
• 0:47
  supposed
• 0:47
  to
• 0:47
  be
• 0:47
  about
• 0:49
  your
• 0:49
  ability
• 0:49
  to
• 0:50
  catch
• 0:50
  a
• 0:50
  detail
• 0:50
  that
• 0:51
  isn't
• 0:51
  quite
• 0:51
  right
• 0:52
  and
• 0:52
  to
• 0:52
  think
• 0:53
  critically
• 0:53
  about
• 0:54
  how
• 0:54
  we
• 0:54
  can
• 0:54
  do
• 0:54
  better
• 0:55
  with
• 0:55
  this.
• 0:56
  Here
• 0:56
  goes
• 0:56
  the
• 0:56
  case.
• 0:57
  Larry
• 0:58
  is
• 0:58
  a
• 0:58
  51
• 0:59
  year
• 0:59
  old
• 0:59
  man
• 1:00
  with
• 1:00
  depression.
• 1:01
  He
• 1:01
  reports
• 1:02
  feeling
• 1:02
  extremely
• 1:03
  groggy
• 1:04
  every
• 1:04
  morning.
• 1:05
  It's
• 1:05
  getting
• 1:06
  harder
• 1:06
  to
• 1:06
  get
• 1:07
  moving,
• 1:07
  even
• 1:08
  though
• 1:08
  his
• 1:08
  mood
• 1:09
  seems
• 1:09
  honestly
• 1:10
  a
• 1:10
  little
• 1:10
  bit
• 1:10
  better.
• 1:11
  Now.
• 1:11
  He's
• 1:11
  been
• 1:11
  on
• 1:11
  Lexapro
• 1:12
  20mg
• 1:13
  for
• 1:13
  about
• 1:14
  a
• 1:14
  year,
• 1:14
  and
• 1:15
  he
• 1:15
  recently
• 1:16
  started
• 1:16
  Wellbutrin
• 1:17
  150mg
• 1:18
  XL
• 1:19
  to
• 1:19
  help
• 1:20
  boost
• 1:20
  his
• 1:20
  motivation.
• 1:22
  Now,
• 1:23
  to
• 1:23
  help
• 1:23
  him
• 1:23
  sleep,
• 1:23
  he's
• 1:24
  been
• 1:24
  taking
• 1:24
  Trazodone
• 1:25
  and
• 1:25
  Atarax
• 1:26
  at
• 1:26
  night.
• 1:26
  100
• 1:27
  milligrams
• 1:27
  of
• 1:27
  Trazodone,
• 1:28
  25
• 1:29
  milligrams
• 1:29
  of
• 1:30
  Atarax.
• 1:31
  Sometimes
• 1:31
  he's
• 1:31
  inclined
• 1:32
  to
• 1:32
  take
• 1:32
  even
• 1:32
  more
• 1:32
  Atarax
• 1:33
  because
• 1:33
  he's
• 1:33
  just
• 1:33
  so
• 1:34
  darn
• 1:34
  jumpy
• 1:35
  and
• 1:35
  wired
• 1:35
  up
• 1:36
  at
• 1:36
  nighttime.
• 1:37
  He
• 1:37
  mentions
• 1:37
  that
• 1:37
  in
• 1:38
  terms
• 1:38
  of
• 1:38
  any
• 1:39
  other
• 1:39
  issues,
• 1:39
  his
• 1:40
  sex
• 1:40
  drive
• 1:40
  is
• 1:40
  not
• 1:41
  what
• 1:41
  it
• 1:41
  used
• 1:41
  to
• 1:41
  be.
• 1:42
  His
• 1:42
  biggest
• 1:43
  complaint
• 1:43
  is
• 1:43
  the
• 1:43
  crushing
• 1:44
  morning
• 1:45
  fatigue.
• 1:46
  He
• 1:46
  takes
• 1:46
  his
• 1:46
  Lexapro
• 1:47
  in
• 1:47
  the
• 1:48
  morning,
• 1:48
  he
• 1:48
  takes
• 1:48
  his
• 1:48
  Wellbutrin
• 1:49
  after
• 1:49
  dinner
• 1:50
  so
• 1:50
  he
• 1:50
  doesn't
• 1:50
  forget.
• 1:51
  Despite
• 1:51
  sleeping
• 1:52
  through
• 1:52
  the
• 1:52
  night,
• 1:53
  he
• 1:53
  wakes
• 1:53
  up
• 1:53
  feeling
• 1:54
  foggy.
• 1:54
  Okay,
• 1:55
  so
• 1:55
  that's
• 1:55
  what
• 1:55
  you
• 1:55
  know
• 1:56
  about
• 1:56
  Larry.
• 1:56
  And
• 1:56
  somewhere
• 1:57
  in
• 1:57
  that
• 1:57
  paragraph,
• 1:58
  I
• 1:58
  threw
• 1:59
  you
• 1:59
  a
• 1:59
  curveball.
• 2:00
  Somewhere
• 2:00
  in
• 2:00
  that
• 2:01
  paragraph,
• 2:01
  my
• 2:01
  friends,
• 2:02
  if
• 2:02
  you
• 2:03
  need
• 2:03
  to
• 2:03
  re
• 2:03
  listen
• 2:03
  to
• 2:03
  it,
• 2:04
  you
• 2:04
  can
• 2:04
  and
• 2:04
  should.
• 2:06
  But
• 2:06
  I
• 2:06
  gave
• 2:06
  you
• 2:07
  a
• 2:07
  detail
• 2:07
  that
• 2:07
  you
• 2:07
  should
• 2:08
  have
• 2:08
  paused
• 2:08
  and
• 2:08
  said,
• 2:09
  wait
• 2:09
  a
• 2:09
  minute,
• 2:10
  what
• 2:10
  the
• 2:10
  hell
• 2:11
  was
• 2:11
  that?
• 2:11
  Hopefully
• 2:12
  you
• 2:12
  caught
• 2:13
  the
• 2:13
  curveball
• 2:14
  before
• 2:15
  we
• 2:15
  get
• 2:15
  to
• 2:15
  that
• 2:15
  curveball.
• 2:17
  You
• 2:17
  can
• 2:17
  pause
• 2:17
  this,
• 2:18
  you
• 2:18
  can
• 2:18
  discuss
• 2:18
  this
• 2:19
  as
• 2:19
  a
• 2:19
  team,
• 2:20
  replay
• 2:20
  his
• 2:21
  case
• 2:21
  study
• 2:21
  and
• 2:22
  talk
• 2:22
  about
• 2:22
  what's
• 2:23
  different,
• 2:23
  what's
• 2:23
  weird
• 2:23
  about
• 2:24
  this,
• 2:24
  right?
• 2:25
  It
• 2:25
  should
• 2:25
  already
• 2:26
  jump
• 2:26
  out
• 2:26
  at
• 2:26
  you
• 2:27
  that
• 2:28
  this
• 2:28
  is
• 2:28
  a
• 2:28
  little
• 2:28
  bizarre,
• 2:29
  right?
• 2:29
  He's
• 2:29
  foggy,
• 2:30
  he's
• 2:30
  sluggish,
• 2:30
  he's
• 2:31
  unrefreshed,
• 2:32
  he's
• 2:32
  groggy.
• 2:33
  Every
• 2:33
  morning.
• 2:34
  That
• 2:34
  seems
• 2:34
  to
• 2:34
  be
• 2:34
  his
• 2:35
  big
• 2:35
  problem.
• 2:35
  And
• 2:36
  why
• 2:36
  is
• 2:36
  he
• 2:36
  so
• 2:36
  groggy
• 2:38
  if
• 2:38
  his
• 2:38
  mood
• 2:39
  is
• 2:39
  actually
• 2:39
  improving?
• 2:40
  Right.
• 2:41
  What's
• 2:41
  the
• 2:41
  deal
• 2:41
  here?
• 2:41
  What
• 2:42
  do
• 2:42
  we
• 2:42
  need
• 2:42
  to
• 2:42
  do?
• 2:43
  And
• 2:45
  your
• 2:45
  first
• 2:45
  inclination
• 2:46
  might
• 2:46
  be
• 2:47
  to
• 2:47
  look
• 2:48
  at
• 2:48
  his
• 2:48
  Trazodone
• 2:49
  and
• 2:49
  his
• 2:49
  Ataracts.
• 2:50
  Why
• 2:50
  is
• 2:50
  he
• 2:51
  on
• 2:51
  100mg
• 2:52
  of
• 2:52
  trazodone
• 2:53
  and
• 2:53
  he's
• 2:53
  taking
• 2:53
  extra
• 2:54
  Atarax.
• 2:55
  That's
• 2:55
  a
• 2:55
  lot
• 2:55
  of
• 2:56
  sedation.
• 2:56
  Why
• 2:57
  is
• 2:57
  he
• 2:57
  taking
• 2:57
  all
• 2:58
  of
• 2:58
  that
• 2:58
  to
• 2:58
  sleep?
• 2:59
  Well,
• 2:59
  that
• 3:00
  must
• 3:00
  be
• 3:00
  why
• 3:00
  he's
• 3:00
  groggy,
• 3:01
  right?
• 3:01
  He's
• 3:02
  taking
• 3:03
  a
• 3:03
  lot
• 3:03
  of
• 3:03
  sedating
• 3:05
  hypnotics
• 3:05
  at
• 3:06
  night.
• 3:06
  And
• 3:07
  maybe
• 3:07
  that's
• 3:07
  why
• 3:07
  he's
• 3:08
  super
• 3:08
  uppity
• 3:09
  and
• 3:09
  he
• 3:09
  can't
• 3:10
  sleep,
• 3:11
  and
• 3:11
  that's
• 3:11
  lingering
• 3:12
  into
• 3:12
  the
• 3:12
  morning.
• 3:12
  And
• 3:13
  he's
• 3:13
  drowsy
• 3:13
  and
• 3:13
  groggy.
• 3:14
  That's
• 3:14
  my
• 3:14
  answer.
• 3:16
  You
• 3:16
  would
• 3:16
  be
• 3:16
  partially
• 3:17
  right.
• 3:17
  You
• 3:18
  might
• 3:18
  have
• 3:18
  caught
• 3:19
  a
• 3:19
  change
• 3:19
  up.
• 3:19
  You
• 3:20
  might
• 3:20
  have
• 3:20
  caught
• 3:21
  a
• 3:21
  slider,
• 3:21
  but
• 3:21
  it
• 3:22
  wasn't
• 3:22
  quite
• 3:22
  the
• 3:22
  curve
• 3:22
  ball.
• 3:23
  I
• 3:23
  threw
• 3:23
  you
• 3:23
  a
• 3:23
  curveball.
• 3:24
  And
• 3:24
  we're
• 3:25
  gonna
• 3:25
  talk
• 3:25
  about
• 3:25
  it
• 3:25
  in
• 3:26
  just
• 3:26
  a
• 3:26
  moment.
• 3:27
  But
• 3:27
  it's
• 3:28
  really
• 3:28
  important
• 3:29
  when
• 3:29
  your
• 3:29
  patient
• 3:30
  comes
• 3:30
  to
• 3:30
  you,
• 3:30
  first
• 3:31
  of
• 3:31
  all,
• 3:31
  to
• 3:31
  assess
• 3:32
  what's
• 3:32
  in
• 3:33
  his
• 3:33
  way.
• 3:33
  Right?
• 3:34
  He
• 3:34
  made
• 3:34
  it
• 3:34
  clear
• 3:35
  the
• 3:35
  sexual
• 3:35
  side
• 3:35
  effects
• 3:36
  are
• 3:36
  in
• 3:36
  his
• 3:36
  way.
• 3:37
  He
• 3:38
  made
• 3:38
  it
• 3:38
  clear
• 3:38
  that
• 3:38
  grogginess
• 3:39
  and
• 3:40
  fogginess
• 3:41
  and
• 3:41
  not
• 3:41
  having
• 3:42
  energies
• 3:42
  in
• 3:42
  his
• 3:42
  way.
• 3:43
  And
• 3:43
  one
• 3:44
  little
• 3:44
  clue
• 3:44
  he
• 3:44
  dropped
• 3:45
  is
• 3:45
  that
• 3:45
  his
• 3:45
  mood
• 3:45
  is
• 3:45
  actually
• 3:46
  improving,
• 3:47
  but
• 3:47
  his
• 3:47
  energy
• 3:48
  levels
• 3:48
  are
• 3:49
  not
• 3:49
  great.
• 3:50
  It's
• 3:50
  a
• 3:50
  bit
• 3:50
  reassuring
• 3:51
  because
• 3:52
  it's
• 3:52
  good
• 3:53
  that
• 3:53
  between
• 3:54
  his
• 3:54
  two
• 3:54
  antidepressants,
• 3:56
  something
• 3:56
  is
• 3:56
  helping
• 3:56
  his
• 3:57
  mood.
• 3:57
  So
• 3:58
  perhaps
• 3:58
  you
• 3:58
  can
• 3:58
  capitalize
• 3:59
  on
• 3:59
  that
• 3:59
  and
• 3:59
  increase
• 4:00
  his
• 4:00
  Wellbutrin.
• 4:02
  But
• 4:03
  something
• 4:03
  is
• 4:03
  still
• 4:04
  amiss
• 4:04
  here.
• 4:05
  You
• 4:05
  have
• 4:05
  that
• 4:05
  sexual
• 4:06
  side
• 4:06
  effect
• 4:06
  that
• 4:06
  is
• 4:07
  problematic.
• 4:07
  And
• 4:08
  it
• 4:08
  more
• 4:08
  than
• 4:08
  likely
• 4:08
  has
• 4:09
  to
• 4:09
  do
• 4:09
  with
• 4:09
  the
• 4:09
  Lexapro.
• 4:10
  SSRI
• 4:10
  induced
• 4:11
  sexual
• 4:11
  dysfunction
• 4:12
  by
• 4:12
  blocking
• 4:12
  the
• 4:13
  reuptake
• 4:13
  of
• 4:13
  serotonin.
• 4:14
  There's
• 4:15
  more
• 4:15
  serotonin
• 4:16
  in
• 4:16
  the
• 4:16
  synapse
• 4:17
  around
• 4:17
  neurons,
• 4:18
  more
• 4:18
  serotonin
• 4:19
  in
• 4:20
  the
• 4:20
  pathways
• 4:21
  of
• 4:21
  those
• 4:22
  five
• 4:22
  HT2C
• 4:24
  receptors
• 4:24
  that
• 4:24
  are
• 4:24
  implicated
• 4:25
  in
• 4:25
  a
• 4:26
  dysfunctional
• 4:26
  sex
• 4:27
  drive.
• 4:27
  So
• 4:27
  Lexapro
• 4:28
  is
• 4:28
  more
• 4:28
  than
• 4:28
  likely
• 4:29
  the
• 4:29
  reason
• 4:29
  he
• 4:30
  has
• 4:30
  sexual
• 4:30
  side
• 4:30
  effects.
• 4:31
  Of
• 4:31
  course,
• 4:31
  it's
• 4:31
  good
• 4:31
  to
• 4:32
  ask
• 4:32
  him.
• 4:32
  When
• 4:33
  did
• 4:33
  those
• 4:33
  happen?
• 4:34
  But
• 4:34
  nine
• 4:35
  times
• 4:35
  out
• 4:35
  of
• 4:35
  10,
• 4:35
  at
• 4:36
  least
• 4:36
  in
• 4:36
  my
• 4:36
  experience,
• 4:36
  it
• 4:37
  is
• 4:37
  correlated
• 4:38
  with
• 4:38
  the
• 4:38
  initiation
• 4:39
  or
• 4:39
  continuation
• 4:40
  of
• 4:40
  SSRIs.
• 4:41
  Okay,
• 4:42
  so
• 4:42
  that's
• 4:42
  a
• 4:43
  problem
• 4:43
  we
• 4:43
  want
• 4:43
  to
• 4:43
  deal
• 4:43
  with.
• 4:44
  He's
• 4:44
  made
• 4:44
  that
• 4:44
  clear
• 4:44
  that
• 4:45
  that's
• 4:45
  his
• 4:45
  problem.
• 4:45
  And
• 4:45
  a
• 4:46
  lack
• 4:46
  of
• 4:46
  energy.
• 4:47
  So
• 4:47
  you
• 4:47
  could
• 4:47
  tell
• 4:47
  him
• 4:48
  right
• 4:48
  here,
• 4:48
  let's
• 4:49
  look
• 4:49
  at
• 4:49
  your
• 4:49
  medications
• 4:50
  at
• 4:50
  night.
• 4:50
  Right?
• 4:50
  What
• 4:51
  would
• 4:51
  be
• 4:51
  one
• 4:51
  way,
• 4:52
  you
• 4:52
  could
• 4:52
  mitigate
• 4:52
  his
• 4:52
  sedation
• 4:53
  right
• 4:53
  off
• 4:54
  the
• 4:54
  bat.
• 4:54
  What
• 4:54
  are
• 4:54
  you
• 4:55
  guys
• 4:55
  thinking?
• 4:56
  You
• 4:56
  wouldn't
• 4:56
  be
• 4:56
  wrong
• 4:56
  to
• 4:57
  say
• 4:57
  we
• 4:57
  could
• 4:57
  lower
• 4:58
  his
• 4:58
  trazodone
• 4:59
  to
• 4:59
  50
• 4:59
  milligrams.
• 5:00
  But
• 5:00
  there's
• 5:00
  a
• 5:01
  reason
• 5:01
  he's
• 5:02
  taking
• 5:02
  more
• 5:02
  and
• 5:02
  more
• 5:03
  Trazodone.
• 5:03
  He
• 5:03
  says
• 5:03
  he
• 5:04
  feels
• 5:04
  really
• 5:04
  wired
• 5:04
  and
• 5:05
  excited
• 5:05
  at
• 5:05
  night.
• 5:06
  Now,
• 5:06
  you
• 5:06
  might
• 5:06
  go
• 5:07
  down
• 5:07
  this
• 5:07
  bipolar
• 5:08
  rabbit
• 5:08
  hole
• 5:08
  and
• 5:08
  make
• 5:08
  sure
• 5:08
  he's
• 5:09
  not
• 5:09
  bipolar
• 5:10
  for
• 5:10
  the
• 5:10
  sake
• 5:11
  of
• 5:11
  our
• 5:11
  game,
• 5:12
  the
• 5:12
  catch
• 5:12
  the
• 5:13
  curveball
• 5:13
  segment.
• 5:14
  I've
• 5:14
  given
• 5:14
  you
• 5:15
  the
• 5:15
  curveball
• 5:15
  here,
• 5:16
  right?
• 5:17
  There's
• 5:17
  not
• 5:17
  some
• 5:18
  surprise
• 5:18
  thing
• 5:18
  I
• 5:19
  haven't
• 5:19
  mentioned.
• 5:19
  In
• 5:20
  other
• 5:20
  words,
• 5:20
  those
• 5:20
  are
• 5:20
  the
• 5:21
  rules
• 5:21
  of
• 5:21
  the
• 5:21
  game
• 5:21
  with
• 5:22
  catch
• 5:22
  the
• 5:22
  curveball.
• 5:23
  This
• 5:23
  isn't
• 5:24
  some.
• 5:24
  Oh,
• 5:24
  by
• 5:24
  the
• 5:25
  way,
• 5:25
  he's
• 5:25
  chugging
• 5:25
  19
• 5:26
  Red
• 5:26
  Bulls
• 5:27
  in
• 5:28
  the
• 5:28
  afternoon.
• 5:28
  No,
• 5:28
  that
• 5:29
  would
• 5:29
  be
• 5:29
  against
• 5:29
  the
• 5:29
  rules
• 5:30
  of
• 5:30
  catch
• 5:30
  the
• 5:30
  curveball.
• 5:31
  Catch
• 5:31
  the
• 5:31
  curveball.
• 5:32
  I
• 5:32
  already
• 5:33
  threw
• 5:33
  you
• 5:33
  the
• 5:33
  pitch,
• 5:34
  so
• 5:34
  now
• 5:35
  it's
• 5:35
  your
• 5:35
  job
• 5:35
  to
• 5:35
  figure
• 5:36
  out
• 5:36
  what
• 5:36
  it
• 5:36
  is.
• 5:36
  I'm
• 5:36
  going
• 5:37
  to
• 5:37
  give
• 5:37
  you
• 5:37
  one
• 5:37
  more
• 5:37
  try.
• 5:37
  We're
• 5:38
  going
• 5:38
  to
• 5:38
  go
• 5:38
  over
• 5:38
  this
• 5:38
  one
• 5:38
  more
• 5:39
  time
• 5:39
  again.
• 5:40
  Larry,
• 5:40
  51
• 5:41
  years
• 5:41
  old,
• 5:41
  mock
• 5:42
  patient.
• 5:42
  He
• 5:43
  has
• 5:43
  depression,
• 5:44
  but
• 5:44
  it's
• 5:44
  gotten
• 5:45
  generally
• 5:45
  better.
• 5:46
  But
• 5:46
  he's
• 5:46
  complaining
• 5:47
  of
• 5:47
  sexual
• 5:47
  side
• 5:47
  effects,
• 5:48
  and
• 5:48
  he's
• 5:48
  just
• 5:49
  too
• 5:49
  darn
• 5:49
  good.
• 5:50
  Groggy.
• 5:50
  He's
• 5:51
  so
• 5:51
  groggy
• 5:52
  that
• 5:52
  he
• 5:53
  is
• 5:53
  taking
• 5:53
  Trazodone
• 5:54
  100
• 5:54
  and
• 5:54
  Atarax
• 5:55
  25
• 5:55
  because
• 5:55
  he
• 5:55
  feels
• 5:56
  so
• 5:56
  darn
• 5:56
  wired
• 5:57
  all
• 5:57
  the
• 5:57
  time.
• 5:59
  Despite
• 5:59
  feeling
• 5:59
  wired,
• 6:00
  he's
• 6:00
  only
• 6:00
  on
• 6:00
  150
• 6:01
  milligrams
• 6:02
  of
• 6:02
  Wellbutrin
• 6:03
  and
• 6:03
  20
• 6:03
  milligrams
• 6:04
  of
• 6:04
  Lexapro.
• 6:05
  He
• 6:05
  takes
• 6:05
  his
• 6:05
  Lexapro
• 6:06
  in
• 6:06
  the
• 6:06
  morning
• 6:06
  as
• 6:06
  Wellbutrin
• 6:07
  at
• 6:07
  night,
• 6:07
  or
• 6:08
  at
• 6:08
  least
• 6:08
  after
• 6:08
  dinner,
• 6:09
  so
• 6:09
  he
• 6:09
  doesn't
• 6:09
  forget.
• 6:10
  Despite
• 6:11
  sleeping
• 6:12
  throughout
• 6:12
  the
• 6:12
  night,
• 6:12
  he's
• 6:12
  still
• 6:13
  foggy
• 6:13
  and
• 6:13
  sluggish.
• 6:14
  The
• 6:14
  curve
• 6:14
  ball
• 6:15
  is
• 6:15
  the
• 6:16
  timing
• 6:16
  of
• 6:16
  his
• 6:16
  medication
• 6:17
  administration.
• 6:18
  He
• 6:18
  should
• 6:19
  not
• 6:19
  be
• 6:19
  taking
• 6:19
  his
• 6:20
  Wellbutrin
• 6:20
  in
• 6:20
  the
• 6:21
  evening.
• 6:21
  Wellbutrin
• 6:22
  should
• 6:22
  be
• 6:22
  taken
• 6:23
  during
• 6:23
  the
• 6:23
  day,
• 6:23
  in
• 6:24
  the
• 6:24
  early
• 6:24
  morning.
• 6:25
  So
• 6:25
  what's
• 6:25
  happening
• 6:26
  is
• 6:26
  he
• 6:26
  has
• 6:27
  an
• 6:27
  abnormally
• 6:28
  high
• 6:29
  serum
• 6:29
  level
• 6:30
  of
• 6:30
  these
• 6:30
  dopaminergic
• 6:31
  noradrenergic
• 6:33
  side
• 6:33
  effects
• 6:33
  in
• 6:34
  the
• 6:34
  middle
• 6:34
  of
• 6:34
  the
• 6:34
  night.
• 7:29
  And
• 7:29
  what's
• 6:35
  happening?
• 7:30
  He's
• 7:30
  trying
• 7:31
  to
• 7:31
  compensate
• 7:31
  by
• 7:31
  taking
• 7:32
  Trazodone
• 7:33
  100
• 7:34
  and
• 7:34
  Atarax
• 7:35
  25.
• 7:35
  Sometimes
• 7:36
  the
• 7:36
  guy's
• 7:36
  taking
• 7:36
  more
• 7:37
  Atarax
• 7:37
  than
• 7:37
  he's
• 7:38
  prescribed,
• 7:39
  which
• 7:39
  unfortunately
• 7:40
  happens
• 7:40
  sometimes
• 7:41
  with
• 7:41
  your
• 7:41
  patients.
• 7:42
  So
• 7:42
  this
• 7:42
  is
• 7:42
  not
• 7:43
  ideal.
• 7:43
  Right?
• 7:43
  You
• 7:44
  have
• 7:44
  this
• 7:44
  med
• 7:44
  in
• 7:45
  the
• 7:45
  wrong
• 7:45
  place
• 7:46
  at
• 7:46
  the
• 7:46
  wrong
• 7:47
  time,
• 7:47
  and
• 7:48
  it's
• 7:48
  causing
• 7:49
  polypharmacy.
• 7:50
  Essential.
• 7:50
  It's
• 7:50
  causing
• 7:51
  more
• 7:51
  sedation,
• 7:52
  and
• 7:52
  that's
• 7:52
  carrying
• 7:53
  on
• 7:53
  into
• 7:53
  the
• 7:53
  morning,
• 7:54
  and
• 7:55
  it's
• 7:55
  just
• 7:55
  not
• 7:56
  really
• 7:56
  serving
• 7:56
  him
• 7:56
  in
• 7:57
  any
• 7:57
  way.
• 7:57
  And
• 7:57
  one
• 7:57
  of
• 7:57
  the
• 7:58
  tip
• 7:58
  offs
• 7:58
  that
• 7:58
  he
• 7:58
  gave
• 7:59
  you
• 7:59
  was
• 7:59
  that,
• 8:00
  okay,
• 8:00
  the
• 8:00
  depression
• 8:01
  is
• 8:01
  helping
• 8:01
  a
• 8:01
  little
• 8:01
  bit,
• 8:02
  but
• 8:02
  my
• 8:02
  energy's
• 8:03
  out
• 8:03
  of
• 8:03
  whack.
• 8:03
  It
• 8:03
  seems
• 8:03
  dysregulated.
• 8:05
  I'm
• 8:05
  not
• 8:05
  getting
• 8:05
  alert
• 8:05
  at
• 8:06
  the
• 8:06
  right
• 8:06
  times.
• 8:06
  Well,
• 8:06
  go
• 8:07
  figure.
• 8:07
  He's
• 8:07
  not
• 8:07
  getting
• 8:07
  alert
• 8:08
  at
• 8:08
  the
• 8:08
  right
• 8:08
  times
• 8:09
  because,
• 8:09
  number
• 8:09
  one,
• 8:10
  he's
• 8:10
  compensating
• 8:11
  by
• 8:11
  adding
• 8:11
  too
• 8:12
  much
• 8:12
  sedating
• 8:13
  medication
• 8:13
  at
• 8:13
  night
• 8:14
  because
• 8:14
  he's
• 8:14
  too
• 8:14
  wired,
• 8:15
  because
• 8:15
  he's
• 8:15
  taking
• 8:15
  his
• 8:16
  Wellbutrin
• 8:16
  at
• 8:16
  the
• 8:16
  wrong
• 8:17
  time.
• 8:17
  He's
• 8:17
  waking
• 8:18
  up
• 8:18
  sedated.
• 8:18
  And
• 8:18
  instead
• 8:19
  of
• 8:19
  having
• 8:19
  Wellbutrin
• 8:20
  to
• 8:20
  take
• 8:20
  in
• 8:20
  the
• 8:20
  morning
• 8:21
  to
• 8:21
  help
• 8:22
  perk
• 8:22
  him
• 8:22
  up
• 8:23
  and
• 8:23
  increase
• 8:23
  his
• 8:24
  energy
• 8:24
  and
• 8:24
  alertness,
• 8:25
  he's
• 8:25
  already
• 8:26
  spent
• 8:26
  that
• 8:26
  Wellbutrin.
• 8:27
  He
• 8:27
  doesn't
• 8:27
  need
• 8:27
  it
• 8:27
  in
• 8:28
  the
• 8:28
  evening.
• 8:28
  Do
• 8:28
  you
• 8:28
  really
• 8:28
  need
• 8:28
  to
• 8:29
  be
• 8:29
  awake
• 8:29
  at
• 8:29
  midnight
• 8:30
  or
• 8:30
  11
• 8:30
  at
• 8:31
  night
• 8:31
  or
• 8:31
  2
• 8:31
  in
• 8:32
  the
• 8:32
  morning?
• 8:32
  No,
• 8:33
  this
• 8:33
  is
• 8:33
  not
• 8:33
  a
• 8:33
  good
• 8:34
  use
• 8:34
  of
• 8:34
  his
• 8:34
  medications.
• 8:36
  A
• 8:36
  lot
• 8:36
  of
• 8:36
  times
• 8:36
  you're
• 8:37
  going
• 8:37
  to
• 8:37
  find
• 8:38
  that
• 8:39
  the
• 8:39
  things
• 8:39
  that
• 8:40
  go
• 8:40
  wrong
• 8:41
  with
• 8:41
  your
• 8:41
  cases
• 8:42
  are
• 8:42
  sometimes
• 8:43
  so
• 8:43
  fundamental
• 8:44
  and
• 8:44
  so
• 8:44
  simple
• 8:44
  to
• 8:45
  fix.
• 8:45
  Other
• 8:45
  times
• 8:45
  they're
• 8:46
  more
• 8:46
  complicated.
• 8:47
  But
• 8:47
  just
• 8:47
  ensuring
• 8:48
  that
• 8:49
  your
• 8:49
  patient
• 8:49
  is
• 8:49
  taking
• 8:50
  the
• 8:50
  medication,
• 8:52
  period,
• 8:52
  and
• 8:52
  there's
• 8:53
  no
• 8:53
  lapses
• 8:53
  in
• 8:54
  adherence,
• 8:55
  that's
• 8:55
  very
• 8:55
  important.
• 8:56
  And
• 8:56
  to
• 8:56
  just
• 8:56
  make
• 8:57
  sure
• 8:57
  they're
• 8:57
  taking
• 8:57
  it
• 8:57
  at
• 8:58
  the
• 8:58
  right
• 8:58
  time,
• 8:58
  you
• 8:58
  can't
• 8:59
  really
• 8:59
  blame
• 8:59
  them
• 8:59
  for
• 8:59
  not
• 9:00
  knowing,
• 9:00
  right?
• 9:01
  I
• 9:01
  mean,
• 9:01
  if
• 9:01
  you
• 9:01
  think
• 9:01
  about
• 9:01
  it,
• 9:02
  if
• 9:02
  you
• 9:02
  zoom
• 9:02
  out
• 9:02
  and
• 9:03
  forget
• 9:03
  everything
• 9:03
  you
• 9:04
  know
• 9:04
  about
• 9:04
  pharmacology
• 9:05
  and
• 9:05
  diagnosis
• 9:06
  and
• 9:06
  all
• 9:07
  this
• 9:07
  receptor
• 9:07
  signaling,
• 9:08
  if
• 9:08
  you
• 9:08
  just
• 9:08
  zoom
• 9:08
  out,
• 9:09
  it's
• 9:09
  not
• 9:10
  insane
• 9:10
  for
• 9:10
  the
• 9:10
  layperson
• 9:11
  to
• 9:11
  assume
• 9:12
  that,
• 9:12
  hey,
• 9:12
  I
• 9:12
  can
• 9:12
  take
• 9:12
  this
• 9:12
  depression
• 9:13
  medication
• 9:14
  and
• 9:14
  my
• 9:14
  depression
• 9:15
  will
• 9:15
  get
• 9:15
  better
• 9:17
  in
• 9:17
  a
• 9:18
  few
• 9:18
  weeks,
• 9:18
  everything
• 9:18
  will
• 9:18
  be
• 9:19
  fine.
• 9:19
  Oh,
• 9:19
  I
• 9:19
  took
• 9:19
  it
• 9:19
  today,
• 9:20
  so
• 9:20
  that's
• 9:20
  all
• 9:20
  that
• 9:20
  matters.
• 9:21
  Doesn't
• 9:21
  matter
• 9:21
  if
• 9:21
  I
• 9:21
  take
• 9:21
  it
• 9:22
  at
• 9:22
  4pm
• 9:23
  or
• 9:23
  6am
• 9:24
  I
• 9:24
  took
• 9:25
  it,
• 9:25
  so
• 9:25
  I'm
• 9:25
  fine.
• 9:25
  Right?
• 9:26
  They
• 9:26
  don't
• 9:27
  always
• 9:27
  understand
• 9:28
  the
• 9:28
  nitty
• 9:29
  gritty
• 9:29
  mechanics
• 9:29
  that
• 9:30
  Wellbutrin
• 9:30
  is
• 9:30
  more
• 9:31
  activating.
• 9:31
  It
• 9:31
  specifically
• 9:32
  targets
• 9:32
  dopamine
• 9:33
  and
• 9:33
  norepinephrine,
• 9:34
  which
• 9:34
  are
• 9:34
  more
• 9:34
  wakefulness
• 9:35
  circuits
• 9:36
  in
• 9:36
  the
• 9:36
  brain
• 9:36
  that
• 9:36
  we
• 9:37
  don't
• 9:37
  want
• 9:37
  hitting
• 9:38
  peak
• 9:38
  plasma
• 9:39
  levels
• 9:39
  in
• 9:40
  the
• 9:40
  wee
• 9:40
  hours
• 9:40
  of
• 9:40
  the
• 9:40
  night.
• 9:41
  Think
• 9:41
  about
• 9:41
  the
• 9:41
  nuance
• 9:42
  involved
• 9:42
  in
• 9:42
  just
• 9:43
  understanding
• 9:43
  Wellbutrin.
• 9:44
  Reflect
• 9:45
  upon
• 9:45
  how
• 9:46
  long
• 9:46
  it
• 9:46
  may
• 9:46
  have
• 9:46
  taken
• 9:47
  you
• 9:47
  to
• 9:48
  even
• 9:48
  get
• 9:48
  to
• 9:48
  the
• 9:48
  point
• 9:48
  in
• 9:49
  your
• 9:49
  life
• 9:49
  where
• 9:49
  you
• 9:49
  knew
• 9:50
  the
• 9:50
  name
• 9:50
  Wellbutrin,
• 9:51
  that
• 9:51
  it
• 9:51
  was
• 9:51
  also
• 9:52
  bupropion
• 9:53
  and,
• 9:53
  and
• 9:53
  that
• 9:53
  it
• 9:54
  targeted
• 9:54
  dopamine
• 9:54
  and
• 9:55
  norepinephrine
• 9:55
  and
• 9:55
  therefore
• 9:56
  needs
• 9:56
  to
• 9:56
  be
• 9:56
  taken
• 9:56
  at
• 9:56
  a
• 9:57
  Certain
• 9:57
  time.
• 9:57
  If
• 9:57
  it
• 9:57
  took
• 9:57
  you
• 9:58
  and
• 9:58
  me
• 9:58
  that
• 9:58
  long
• 9:59
  to
• 9:59
  learn
• 9:59
  that
• 10:00
  folks
• 10:00
  who
• 10:00
  are
• 10:00
  engineers,
• 10:01
  architects,
• 10:02
  librarians,
• 10:03
  or
• 10:03
  they
• 10:03
  have
• 10:03
  other
• 10:03
  jobs
• 10:04
  and
• 10:04
  passions,
• 10:04
  they're
• 10:05
  not
• 10:05
  going
• 10:05
  to
• 10:05
  know
• 10:05
  that
• 10:05
  out
• 10:05
  of
• 10:06
  the,
• 10:06
  out
• 10:06
  of
• 10:06
  the
• 10:06
  gate.
• 10:07
  So
• 10:07
  we
• 10:07
  have
• 10:07
  to
• 10:07
  have
• 10:08
  compassion
• 10:08
  for
• 10:08
  that.
• 10:08
  We
• 10:09
  have
• 10:09
  a
• 10:09
  curse
• 10:09
  of
• 10:09
  knowledge,
• 10:10
  right?
• 10:10
  That's
• 10:10
  one
• 10:11
  of
• 10:11
  the
• 10:11
  most
• 10:11
  dangerous
• 10:11
  things
• 10:12
  that
• 10:13
  we
• 10:13
  confront
• 10:13
  when
• 10:13
  we
• 10:14
  graduate
• 10:14
  is
• 10:14
  a
• 10:14
  curse
• 10:15
  of
• 10:15
  knowledge.
• 10:15
  We
• 10:15
  will
• 10:16
  have
• 10:16
  learned
• 10:16
  a
• 10:16
  thousand
• 10:17
  times
• 10:17
  over
• 10:17
  that
• 10:17
  Wellbutrin
• 10:18
  needs
• 10:18
  to
• 10:18
  be
• 10:18
  taken
• 10:19
  in
• 10:19
  the
• 10:19
  morning.
• 10:20
  And
• 10:20
  we're
• 10:20
  cursed
• 10:21
  with
• 10:21
  that
• 10:21
  because
• 10:21
  we
• 10:21
  think
• 10:22
  it's
• 10:22
  so
• 10:22
  obvious
• 10:22
  that
• 10:22
  every
• 10:23
  patient
• 10:23
  knows
• 10:23
  that
• 10:23
  now
• 10:24
  all
• 10:24
  of
• 10:24
  a
• 10:24
  sudden
• 10:24
  you're
• 10:24
  busy
• 10:25
  in
• 10:25
  a
• 10:25
  clinic
• 10:25
  and
• 10:26
  you
• 10:26
  don't
• 10:26
  even
• 10:27
  take
• 10:27
  the
• 10:27
  time
• 10:27
  to
• 10:27
  write
• 10:28
  necessarily
• 10:28
  that
• 10:29
  well
• 10:29
  in
• 10:29
  your
• 10:29
  pharmacy
• 10:30
  instructions
• 10:31
  that
• 10:31
  Wellbutrin
• 10:32
  has
• 10:32
  to
• 10:32
  be
• 10:32
  taken
• 10:32
  every
• 10:32
  morning,
• 10:33
  I
• 10:33
  hope
• 10:33
  you
• 10:33
  do.
• 10:33
  That's
• 10:34
  good
• 10:34
  practice,
• 10:34
  of
• 10:35
  course,
• 10:35
  to
• 10:36
  let
• 10:36
  your
• 10:36
  patients
• 10:36
  know
• 10:37
  and
• 10:37
  tee
• 10:37
  them
• 10:37
  up
• 10:37
  for
• 10:38
  success.
• 10:38
  But
• 10:38
  let's
• 10:39
  say
• 10:39
  you're
• 10:39
  crunched
• 10:39
  with
• 10:40
  30
• 10:40
  minute
• 10:40
  appointments
• 10:41
  and
• 10:41
  the
• 10:41
  systems
• 10:42
  you're
• 10:42
  working
• 10:42
  on
• 10:42
  are
• 10:43
  clunky
• 10:43
  or
• 10:43
  inoperative,
• 10:44
  and
• 10:44
  you
• 10:44
  just
• 10:45
  don't
• 10:45
  include
• 10:45
  that.
• 10:45
  And
• 10:45
  it
• 10:45
  just
• 10:45
  says
• 10:46
  take
• 10:46
  one,
• 10:47
  you
• 10:47
  know,
• 10:47
  150
• 10:48
  milligrams
• 10:48
  every
• 10:48
  day,
• 10:49
  and
• 10:49
  then
• 10:49
  boom,
• 10:49
  all
• 10:50
  of
• 10:50
  a
• 10:50
  sudden
• 10:50
  your
• 10:51
  patient's
• 10:51
  kind
• 10:51
  of
• 10:51
  set
• 10:51
  up
• 10:52
  for
• 10:52
  failure.
• 10:53
  So
• 10:53
  in
• 10:54
  this
• 10:54
  case,
• 10:54
  it's
• 10:54
  a
• 10:54
  very
• 10:55
  simple
• 10:55
  fix.
• 10:55
  And
• 10:56
  the
• 10:56
  beautiful
• 10:56
  part
• 10:57
  about
• 10:57
  this
• 10:57
  case,
• 10:57
  my
• 10:58
  friends,
• 10:58
  is
• 10:59
  we're
• 10:59
  able
• 10:59
  to
• 10:59
  kill
• 11:00
  like
• 11:00
  two
• 11:00
  or
• 11:00
  three
• 11:00
  birds
• 11:01
  with
• 11:01
  one
• 11:01
  stone
• 11:01
  here.
• 11:02
  Number
• 11:02
  one,
• 11:03
  we
• 11:03
  switch
• 11:03
  the
• 11:03
  Wellbutrin
• 11:04
  to
• 11:04
  the
• 11:04
  morning.
• 11:04
  He's
• 11:05
  going
• 11:05
  to
• 11:05
  be
• 11:05
  more
• 11:06
  alert
• 11:06
  throughout
• 11:06
  the
• 11:07
  morning.
• 11:07
  Now,
• 11:07
  he
• 11:07
  won't
• 11:07
  be
• 11:07
  as
• 11:08
  foggy
• 11:08
  or
• 11:08
  sedated.
• 11:09
  He
• 11:09
  also
• 11:09
  won't
• 11:10
  be
• 11:10
  as
• 11:10
  wired
• 11:10
  at
• 11:11
  night,
• 11:11
  meaning
• 11:12
  he
• 11:12
  can
• 11:12
  kind
• 11:12
  of
• 11:12
  cool
• 11:12
  off
• 11:12
  on
• 11:13
  the
• 11:13
  trazodone
• 11:13
  a
• 11:13
  little
• 11:14
  bit.
• 11:14
  If
• 11:14
  it's
• 11:14
  as
• 11:14
  needed,
• 11:14
  we
• 11:15
  can
• 11:15
  kind
• 11:15
  of
• 11:15
  drop
• 11:15
  him
• 11:15
  down
• 11:16
  to
• 11:16
  50
• 11:16
  milligrams.
• 11:17
  He
• 11:17
  may
• 11:17
  or
• 11:17
  may
• 11:17
  not
• 11:18
  even
• 11:18
  have
• 11:18
  to
• 11:18
  take
• 11:18
  that
• 11:18
  Atarax
• 11:19
  if
• 11:20
  he
• 11:20
  doesn't
• 11:20
  need
• 11:20
  it.
• 11:20
  That
• 11:21
  might
• 11:21
  be
• 11:21
  a
• 11:21
  little
• 11:21
  redundant
• 11:22
  if
• 11:22
  the
• 11:22
  Trazodone
• 11:23
  50
• 11:23
  is
• 11:23
  helping
• 11:24
  him
• 11:24
  sleep
• 11:24
  just
• 11:24
  fine.
• 11:25
  So
• 11:25
  the
• 11:26
  Wellbutrin
• 11:26
  is
• 11:26
  not
• 11:26
  interfering.
• 11:27
  He's
• 11:27
  getting
• 11:27
  more
• 11:28
  alert
• 11:28
  in
• 11:28
  the
• 11:28
  morning.
• 11:28
  He's
• 11:29
  building
• 11:29
  a
• 11:29
  sleep
• 11:29
  drive.
• 11:30
  Now,
• 11:30
  because
• 11:30
  the
• 11:30
  Wellbutrin
• 11:31
  is
• 11:31
  building
• 11:31
  up
• 11:31
  that
• 11:32
  sleep
• 11:32
  drive
• 11:33
  throughout
• 11:33
  the
• 11:33
  day,
• 11:33
  it's
• 11:34
  promoting
• 11:34
  wakefulness
• 11:35
  so
• 11:35
  that
• 11:35
  by
• 11:36
  the
• 11:36
  time
• 11:36
  he's
• 11:36
  ready
• 11:36
  to
• 11:36
  sleep,
• 11:37
  he
• 11:37
  can
• 11:37
  sleep.
• 11:37
  And
• 11:38
  if
• 11:38
  you
• 11:38
  wanted
• 11:39
  to,
• 11:39
  if
• 11:39
  he
• 11:39
  still
• 11:39
  was
• 11:40
  showing
• 11:40
  residual
• 11:40
  depressive
• 11:41
  scores
• 11:41
  on
• 11:41
  his
• 11:41
  PHQ9
• 11:43
  and
• 11:43
  he
• 11:43
  has
• 11:43
  sexual
• 11:44
  dysfunction
• 11:45
  and
• 11:45
  he's
• 11:45
  still
• 11:46
  a
• 11:46
  little
• 11:46
  foggy,
• 11:46
  well,
• 11:46
  if
• 11:47
  you
• 11:47
  raise
• 11:47
  that
• 11:47
  Wellbutrin
• 11:48
  to
• 11:48
  300
• 11:48
  milligrams
• 11:49
  every
• 11:49
  morning,
• 11:50
  you
• 11:50
  might
• 11:50
  be
• 11:50
  able
• 11:50
  to
• 11:51
  better
• 11:51
  counter
• 11:52
  his
• 11:52
  sex
• 11:53
  drive.
• 11:53
  Remember
• 11:54
  that
• 11:54
  when
• 11:54
  you
• 11:55
  increase
• 11:55
  SSRIs
• 11:56
  or
• 11:56
  start
• 11:56
  SSRIs,
• 11:57
  they
• 11:57
  have
• 11:57
  a
• 11:57
  dampening
• 11:58
  effect
• 11:58
  on
• 11:58
  dopamine
• 11:59
  on
• 11:59
  those
• 12:00
  dopaminergic
• 12:00
  circuits.
• 12:01
  And
• 12:01
  that
• 12:02
  can
• 12:02
  dampen
• 12:02
  sex
• 12:02
  drive
• 12:03
  by
• 12:03
  boosting
• 12:04
  his
• 12:04
  dopaminergic
• 12:05
  drive
• 12:05
  by
• 12:06
  increasing
• 12:06
  the
• 12:06
  Wellbutrin
• 12:07
  to
• 12:07
  300
• 12:07
  milligrams.
• 12:08
  Now
• 12:08
  you're
• 12:09
  countering
• 12:09
  his
• 12:09
  daytime
• 12:10
  sedation,
• 12:10
  fogginess,
• 12:11
  concentration
• 12:11
  problems.
• 12:12
  Now
• 12:12
  you're
• 12:12
  countering
• 12:13
  his
• 12:13
  sexual
• 12:13
  side
• 12:13
  effects
• 12:14
  by
• 12:14
  adjusting
• 12:15
  the
• 12:15
  timing.
• 12:15
  You're
• 12:16
  also
• 12:17
  allowing
• 12:17
  for
• 12:17
  a
• 12:18
  more
• 12:18
  nimble,
• 12:19
  slick
• 12:20
  pharmacy
• 12:21
  regimen,
• 12:22
  medication
• 12:22
  regimen
• 12:23
  because
• 12:23
  he's
• 12:23
  not
• 12:24
  going
• 12:24
  to
• 12:24
  get
• 12:24
  so
• 12:24
  sauced
• 12:25
  at
• 12:25
  night
• 12:25
  with
• 12:25
  all
• 12:25
  this
• 12:25
  sedation.
• 12:26
  So
• 12:27
  that's
• 12:28
  killing
• 12:28
  three
• 12:28
  birds
• 12:28
  with
• 12:28
  one
• 12:29
  stone.
• 12:29
  I
• 12:29
  think
• 12:29
  it's
• 12:29
  great.
• 12:30
  And
• 12:30
  that's
• 12:30
  probably
• 12:31
  all
• 12:31
  this
• 12:31
  patient
• 12:31
  will
• 12:31
  need.
• 12:32
  In
• 12:32
  particular,
• 12:33
  you
• 12:33
  can
• 12:33
  monitor
• 12:33
  him
• 12:34
  and
• 12:34
  my
• 12:34
  monitor
• 12:34
  the
• 12:35
  sex
• 12:35
  drive,
• 12:35
  see
• 12:35
  if
• 12:35
  that
• 12:36
  was
• 12:36
  fixed
• 12:36
  with
• 12:36
  Wellbutrin.
• 12:37
  That's
• 12:37
  a
• 12:37
  whole
• 12:38
  other
• 12:38
  conversation.
• 12:39
  Make
• 12:39
  sure
• 12:39
  that
• 12:39
  the
• 12:40
  Lexapro
• 12:40
  is
• 12:41
  doing
• 12:41
  its
• 12:41
  job
• 12:41
  right.
• 12:41
  If
• 12:42
  you
• 12:42
  find
• 12:42
  that
• 12:42
  it's
• 12:42
  only
• 12:43
  caused
• 12:43
  him
• 12:43
  sexual
• 12:43
  side
• 12:44
  effects
• 12:44
  and
• 12:45
  he
• 12:45
  doesn't
• 12:45
  have
• 12:45
  a
• 12:45
  whole
• 12:46
  lot
• 12:46
  more
• 12:46
  to
• 12:46
  praise
• 12:47
  about
• 12:47
  it,
• 12:47
  then
• 12:48
  I
• 12:48
  would
• 12:48
  start
• 12:48
  eyeballing
• 12:49
  that
• 12:49
  and
• 12:49
  see
• 12:49
  if
• 12:50
  we
• 12:50
  can
• 12:50
  lower
• 12:51
  it,
• 12:51
  discontinue
• 12:52
  it
• 12:52
  and
• 12:52
  just
• 12:52
  stay
• 12:52
  with
• 12:52
  the
• 12:53
  Wellbutrin.
• 12:54
  Again,
• 12:54
  the
• 12:54
  whole
• 12:55
  point
• 12:55
  today
• 12:55
  was
• 12:55
  to
• 12:55
  see
• 12:55
  if
• 12:56
  you
• 12:56
  could
• 12:56
  catch
• 12:56
  the
• 12:56
  curve
• 12:57
  ball,
• 12:57
  that
• 12:57
  one
• 12:57
  little
• 12:58
  detail
• 12:58
  that
• 12:58
  we
• 12:58
  tucked
• 12:59
  in
• 12:59
  there
• 12:59
  that
• 13:00
  totally
• 13:00
  derails
• 13:01
  the
• 13:01
  entire
• 13:01
  case
• 13:02
  and
• 13:02
  if
• 13:02
  it's
• 13:03
  fixed
• 13:03
  or
• 13:03
  addressed
• 13:04
  could
• 13:05
  mean
• 13:05
  all
• 13:05
  of
• 13:05
  the
• 13:05
  difference
• 13:06
  between
• 13:06
  more
• 13:06
  motivation,
• 13:07
  less
• 13:08
  insomnia,
• 13:09
  less
• 13:09
  sedation
• 13:09
  in
• 13:09
  the
• 13:10
  morning,
• 13:10
  and
• 13:10
  reduced
• 13:11
  sexual
• 13:11
  side
• 13:11
  effects.
• 13:12
  All
• 13:12
  of
• 13:12
  the
• 13:13
  above.
• 13:13
  Pretty
• 13:13
  cool.
• 13:14
  I
• 13:14
  hope
• 13:14
  you
• 13:14
  really
• 13:14
  enjoyed
• 13:15
  this.
• 13:15
  My
• 13:16
  friends.
• 13:17
  I
• 13:17
  can't
• 13:17
  emphasize
• 13:18
  enough
• 13:18
  for
• 13:18
  you
• 13:18
  to
• 13:18
  become
• 13:19
  Patreon
• 13:19
  members
• 13:20
  because
• 13:20
  becoming
• 13:21
  members
• 13:22
  you
• 13:22
  get
• 13:22
  all
• 13:23
  of
• 13:23
  these
• 13:23
  beautiful
• 13:24
  slide
• 13:24
  decks,
• 13:24
  chock
• 13:25
  full
• 13:25
  of
• 13:25
  evidence
• 13:25
  based
• 13:26
  pearls
• 13:26
  and
• 13:26
  information
• 13:27
  resources.
• 13:27
  For
• 13:28
  you
• 13:28
  to
• 13:28
  be
• 13:29
  at
• 13:29
  the
• 13:29
  top
• 13:29
  of
• 13:29
  your
• 13:29
  clinical
• 13:30
  game,
• 13:30
  it's
• 13:31
  really
• 13:31
  important
• 13:31
  you
• 13:32
  get
• 13:32
  early
• 13:32
  episode
• 13:33
  drops.
• 13:33
  You
• 13:33
  even
• 13:33
  get
• 13:33
  bonus
• 13:34
  episode
• 13:34
  drops.
• 13:35
  Direct
• 13:35
  contact
• 13:36
  with
• 13:36
  me
• 13:36
  where
• 13:36
  we
• 13:36
  can
• 13:37
  talk
• 13:37
  about
• 13:37
  future
• 13:38
  episode
• 13:38
  recommendations,
• 13:39
  things
• 13:40
  that
• 13:40
  you
• 13:40
  want
• 13:40
  to
• 13:40
  learn
• 13:40
  or
• 13:41
  share.
• 13:41
  Definitely
• 13:42
  a
• 13:42
  really
• 13:42
  cool
• 13:43
  idea.
• 13:43
  Cool
• 13:43
  community.
• 13:43
  We're
• 13:44
  growing
• 13:44
  fast
• 13:44
  and
• 13:45
  we're
• 13:45
  grateful
• 13:45
  for
• 13:46
  every
• 13:46
  single
• 13:46
  one
• 13:47
  of
• 13:47
  you
• 13:47
  out
• 13:47
  there
• 13:47
  who's
• 13:48
  sharing
• 13:48
  this
• 13:48
  with
• 13:48
  your
• 13:49
  cohort
• 13:49
  to
• 13:50
  up
• 13:50
  your
• 13:50
  game.
• 13:51
  Much
• 13:51
  appreciated
• 13:52
  to
• 13:52
  all
• 13:52
  of
• 13:52
  you.
• 13:53
  If
• 13:53
  nothing
• 13:53
  else,
• 13:53
  please
• 13:53
  run
• 13:54
  over
• 13:54
  to
• 13:54
  Apple
• 13:54
  and
• 13:54
  give
• 13:55
  us
• 13:55
  five
• 13:55
  stars.
• 13:55
  Apple
• 13:56
  podcast.
• 13:56
  Five
• 13:56
  stars
• 13:57
  and
• 13:57
  a
• 13:58
  comment.
• 13:58
  Anyway,
• 13:59
  I
• 13:59
  love
• 13:59
  you
• 13:59
  all.
• 14:00
  Take
• 14:00
  care.
• 14:00
  Signing
• 14:01
  off.
• 14:01
  Bye
• 14:01
  bye.