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Why Lexapro Might be a Uniquely Important Tool in Your Medication Arsenal · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back
• 0:06
  to
• 0:06
  another
• 0:06
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:07
  and
• 0:08
  Prep
• 0:09
  npz.
• 0:09
  Here,
• 0:10
  your
• 0:10
  preceptor
• 0:11
  in
• 0:11
  your
• 0:11
  pocket.
• 0:12
  Before
• 0:13
  we
• 0:13
  begin
• 0:14
  today's
• 0:14
  episode,
• 0:15
  I
• 0:15
  highly
• 0:16
  encourage
• 0:16
  all
• 0:17
  of
• 0:17
  you
• 0:17
  to
• 0:18
  go
• 0:18
  over
• 0:18
  to
• 0:18
  our
• 0:19
  show
• 0:19
  notes
• 0:19
  and
• 0:20
  become
• 0:20
  Patreon
• 0:20
  members.
• 0:21
  We
• 0:21
  have
• 0:21
  beautiful
• 0:22
  slide
• 0:22
  decks
• 0:22
  full
• 0:23
  of
• 0:23
  evidence
• 0:23
  based
• 0:23
  information,
• 0:24
  clinical
• 0:24
  tools
• 0:25
  and
• 0:25
  resources
• 0:26
  right
• 0:26
  at
• 0:27
  your
• 0:27
  fingertips.
• 0:27
  You
• 0:27
  get
• 0:28
  early
• 0:28
  episode
• 0:28
  drops,
• 0:29
  you
• 0:29
  get
• 0:29
  bonus
• 0:30
  episode
• 0:30
  drops
• 0:30
  to
• 0:31
  empower
• 0:31
  you
• 0:32
  in
• 0:32
  your
• 0:32
  practice,
• 0:33
  to
• 0:33
  empower
• 0:33
  you
• 0:34
  to
• 0:34
  pass
• 0:34
  your
• 0:34
  boards.
• 0:35
  And
• 0:35
  more
• 0:35
  importantly,
• 0:36
  even
• 0:36
  one
• 0:36
  pearl
• 0:37
  can
• 0:37
  radically
• 0:38
  change
• 0:38
  someone's
• 0:38
  day,
• 0:39
  maybe
• 0:39
  even
• 0:39
  their
• 0:39
  life.
• 0:40
  Highly
• 0:40
  recommend
• 0:41
  it.
• 0:41
  If
• 0:41
  not,
• 0:41
  please
• 0:42
  subscribe
• 0:42
  and
• 0:43
  rate
• 0:43
  us
• 0:43
  on
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  Apple
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  Podcasts
• 0:45
  with
• 0:45
  a
• 0:45
  nice
• 0:45
  little
• 0:45
  comment.
• 0:46
  We
• 0:46
  love
• 0:46
  that.
• 0:47
  All
• 0:47
  right,
• 0:47
  my
• 0:48
  friends,
• 0:48
  today
• 0:48
  we're
• 0:49
  going
• 0:49
  to
• 0:49
  talk
• 0:50
  about
• 0:51
  antidepressants.
• 0:53
  If
• 0:53
  they
• 0:53
  all
• 0:53
  seem
• 0:53
  the
• 0:54
  same
• 0:54
  to
• 0:54
  you,
• 0:54
  they
• 0:55
  are
• 0:55
  not
• 0:55
  all
• 0:55
  the
• 0:55
  same.
• 0:57
  Sure,
• 0:57
  you
• 0:58
  might
• 0:58
  have
• 0:58
  learned
• 0:59
  in
• 0:59
  school
• 1:00
  that
• 1:02
  they
• 1:02
  all
• 1:03
  have
• 1:03
  more
• 1:03
  or
• 1:03
  less
• 1:04
  the
• 1:04
  same
• 1:04
  efficacy.
• 1:05
  That
• 1:05
  may
• 1:06
  or
• 1:06
  may
• 1:06
  not
• 1:06
  be
• 1:06
  true.
• 1:07
  But
• 1:08
  the
• 1:09
  evidence,
• 1:10
  the
• 1:10
  devil
• 1:11
  is
• 1:11
  in
• 1:11
  the
• 1:11
  details.
• 1:12
  Depending
• 1:12
  on
• 1:12
  the
• 1:12
  patient
• 1:13
  in
• 1:13
  front
• 1:13
  of
• 1:13
  you,
• 1:14
  each
• 1:15
  of
• 1:15
  these
• 1:15
  antidepressants
• 1:16
  has
• 1:17
  subtle
• 1:18
  benefits
• 1:19
  and
• 1:19
  subtle
• 1:19
  drawbacks.
• 1:20
  If
• 1:20
  you
• 1:20
  have
• 1:20
  a
• 1:20
  patient
• 1:21
  who's
• 1:21
  rather
• 1:21
  heavy
• 1:22
  and
• 1:22
  does
• 1:23
  not
• 1:23
  want
• 1:23
  to
• 1:23
  gain
• 1:23
  weight,
• 1:24
  you
• 1:24
  certainly
• 1:24
  don't
• 1:24
  want
• 1:25
  to
• 1:25
  give
• 1:25
  that
• 1:25
  patient
• 1:25
  Paxil.
• 1:26
  If
• 1:26
  a
• 1:26
  patient
• 1:27
  is
• 1:27
  pregnant,
• 1:27
  you
• 1:28
  certainly
• 1:28
  don't
• 1:28
  want
• 1:28
  to
• 1:28
  give
• 1:28
  that
• 1:29
  patient
• 1:29
  Paxil.
• 1:30
  The
• 1:31
  goal
• 1:31
  here
• 1:32
  is
• 1:32
  to
• 1:32
  empower
• 1:33
  you
• 1:33
  with
• 1:33
  information.
• 1:34
  Not
• 1:34
  all
• 1:35
  antidepressants
• 1:35
  are
• 1:36
  created
• 1:36
  equal
• 1:36
  because
• 1:36
  not
• 1:37
  all
• 1:37
  patients
• 1:37
  are
• 1:38
  created
• 1:38
  equal.
• 1:39
  Every
• 1:39
  patient
• 1:40
  has
• 1:40
  a
• 1:40
  unique
• 1:40
  makeup,
• 1:41
  and
• 1:41
  your
• 1:41
  job
• 1:42
  is
• 1:42
  to
• 1:42
  kind
• 1:43
  of
• 1:43
  like
• 1:43
  someone
• 1:43
  who's
• 1:44
  tailoring
• 1:44
  a
• 1:44
  suit.
• 1:45
  You're
• 1:45
  measuring
• 1:46
  your
• 1:46
  ankles,
• 1:46
  your
• 1:46
  waist,
• 1:47
  your
• 1:47
  neck,
• 1:47
  your
• 1:47
  shoulders
• 1:48
  for
• 1:48
  the
• 1:48
  females
• 1:48
  out
• 1:49
  there.
• 1:49
  When
• 1:49
  you
• 1:50
  get
• 1:50
  dresses
• 1:50
  fitted
• 1:51
  for
• 1:51
  you,
• 1:51
  they're
• 1:51
  measuring
• 1:52
  your
• 1:52
  waist,
• 1:53
  your
• 1:53
  shoulder
• 1:53
  length,
• 1:54
  the
• 1:54
  length
• 1:55
  of
• 1:55
  your
• 1:55
  back.
• 1:56
  I'm
• 1:56
  not
• 1:56
  exactly
• 1:56
  sure
• 1:57
  what
• 1:57
  they
• 1:57
  do
• 1:57
  for
• 1:57
  dress
• 1:58
  fittings,
• 1:59
  but
• 1:59
  you
• 1:59
  get
• 1:59
  my
• 2:00
  point.
• 2:00
  Your
• 2:00
  goal
• 2:01
  is
• 2:01
  to
• 2:01
  really
• 2:01
  customize
• 2:02
  the
• 2:03
  antidepressant
• 2:04
  and
• 2:04
  tailor
• 2:05
  it
• 2:05
  to
• 2:05
  the
• 2:05
  patient
• 2:06
  in
• 2:06
  front
• 2:06
  of
• 2:06
  you.
• 2:07
  This
• 2:07
  episode's
• 2:08
  a
• 2:08
  little
• 2:08
  different,
• 2:09
  though.
• 2:09
  This
• 2:10
  is
• 2:10
  more
• 2:10
  about
• 2:11
  what
• 2:11
  do
• 2:11
  you
• 2:11
  do
• 2:11
  as
• 2:12
  a
• 2:12
  conservative
• 2:14
  measure.
• 2:14
  In
• 2:14
  other
• 2:14
  words,
• 2:15
  is
• 2:15
  there
• 2:15
  an
• 2:16
  antidepressant
• 2:16
  out
• 2:17
  there
• 2:17
  that
• 2:17
  is
• 2:18
  just
• 2:18
  kind
• 2:18
  of
• 2:18
  safer
• 2:19
  or
• 2:19
  less
• 2:19
  offensive
• 2:20
  than
• 2:20
  maybe
• 2:20
  some
• 2:20
  of
• 2:20
  the
• 2:21
  other
• 2:21
  ones?
• 2:21
  A
• 2:22
  really
• 2:22
  cool
• 2:22
  study
• 2:23
  in
• 2:23
  BMC
• 2:24
  Psychiatry
• 2:25
  published
• 2:25
  in
• 2:25
  2023
• 2:27
  looked
• 2:27
  at
• 2:27
  this
• 2:27
  question
• 2:28
  and
• 2:29
  specifically
• 2:29
  looked
• 2:30
  at
• 2:30
  Lexapro
• 2:31
  and
• 2:31
  how
• 2:31
  it
• 2:32
  squared
• 2:32
  off
• 2:33
  among
• 2:33
  other
• 2:34
  antidepressants.
• 2:35
  What
• 2:35
  they
• 2:35
  found
• 2:35
  was
• 2:35
  amazing
• 2:36
  and
• 2:36
  very
• 2:36
  interesting
• 2:37
  and
• 2:37
  I
• 2:37
  think
• 2:37
  deeply
• 2:38
  practical
• 2:38
  for
• 2:39
  what
• 2:39
  we
• 2:39
  do
• 2:39
  on
• 2:39
  a
• 2:40
  daily
• 2:40
  basis.
• 2:41
  And
• 2:41
  I
• 2:41
  think
• 2:41
  it's
• 2:41
  gonna
• 2:42
  be
• 2:42
  really
• 2:43
  exciting
• 2:43
  to
• 2:43
  talk
• 2:44
  about
• 2:44
  today.
• 2:45
  This
• 2:45
  isn't
• 2:45
  nursing
• 2:45
  school.
• 2:46
  Okay,
• 2:46
  this
• 2:47
  is
• 2:47
  supposed
• 2:48
  to
• 2:48
  be
• 2:48
  fun.
• 2:48
  I'm
• 2:49
  your
• 2:49
  preceptor
• 2:49
  in
• 2:49
  your
• 2:49
  pocket.
• 2:50
  I'm
• 2:50
  just
• 2:50
  a
• 2:50
  guy
• 2:50
  who
• 2:51
  whispers
• 2:51
  cool
• 2:51
  little
• 2:52
  facts
• 2:52
  or
• 2:52
  studies
• 2:53
  and
• 2:53
  general
• 2:54
  opinions
• 2:55
  and
• 2:55
  you
• 2:55
  can
• 2:56
  take
• 2:56
  what
• 2:56
  you
• 2:56
  will
• 2:56
  from
• 2:56
  them.
• 2:57
  So
• 2:57
  what
• 2:58
  did
• 2:58
  this
• 2:58
  BMC
• 2:59
  study
• 2:59
  do?
• 3:00
  Well,
• 3:00
  it
• 3:00
  was
• 3:00
  a
• 3:00
  meta
• 3:01
  analysis
• 3:01
  of
• 3:01
  30
• 3:02
  randomized
• 3:02
  controlled
• 3:03
  trials
• 3:04
  of
• 3:04
  patients
• 3:05
  who
• 3:05
  were
• 3:05
  18
• 3:06
  years
• 3:06
  or
• 3:06
  older
• 3:06
  with
• 3:06
  a
• 3:07
  primary
• 3:07
  diagnosis
• 3:08
  of
• 3:08
  major
• 3:08
  depression,
• 3:09
  comparing
• 3:09
  Lexapro
• 3:10
  to.
• 3:10
  To
• 3:10
  other
• 3:10
  antidepressants.
• 3:12
  Now,
• 3:12
  my
• 3:12
  friends,
• 3:12
  it's
• 3:13
  really
• 3:13
  important
• 3:13
  when
• 3:13
  you
• 3:14
  look
• 3:14
  at
• 3:14
  a
• 3:14
  journal
• 3:14
  article
• 3:16
  that
• 3:16
  you
• 3:17
  ask
• 3:17
  yourself
• 3:18
  very
• 3:19
  simply,
• 3:19
  very
• 3:19
  quickly,
• 3:20
  are
• 3:21
  the
• 3:21
  people
• 3:21
  that
• 3:22
  they're
• 3:22
  studying
• 3:22
  in
• 3:22
  this
• 3:23
  journal
• 3:23
  article
• 3:23
  relevant
• 3:24
  to
• 3:24
  me
• 3:24
  in
• 3:24
  my
• 3:24
  practice?
• 3:25
  If
• 3:25
  this
• 3:26
  article
• 3:26
  was
• 3:27
  understanding
• 3:28
  the
• 3:28
  effects
• 3:29
  of
• 3:29
  Lexapro
• 3:30
  on
• 3:30
  an
• 3:31
  Amazonian
• 3:31
  tribe
• 3:32
  in
• 3:32
  their
• 3:32
  80s
• 3:33
  with
• 3:34
  prostate
• 3:34
  cancer,
• 3:35
  that's
• 3:36
  not
• 3:36
  going
• 3:36
  to
• 3:36
  be
• 3:37
  very
• 3:37
  relevant
• 3:37
  to
• 3:38
  the
• 3:38
  average
• 3:39
  outpatient
• 3:40
  clinic
• 3:41
  run
• 3:41
  of
• 3:42
  the
• 3:42
  mill
• 3:43
  depression
• 3:44
  that
• 3:44
  you
• 3:44
  might
• 3:44
  see
• 3:44
  in
• 3:45
  America.
• 3:45
  Right?
• 3:45
  Because
• 3:46
  there's
• 3:46
  huge
• 3:46
  cultural
• 3:47
  differences,
• 3:48
  there
• 3:49
  is
• 3:49
  huge
• 3:50
  age
• 3:50
  gap
• 3:50
  there.
• 3:51
  80
• 3:51
  year
• 3:51
  olds,
• 3:52
  they
• 3:52
  might
• 3:53
  have
• 3:53
  a
• 3:53
  lot
• 3:53
  of
• 3:53
  medical
• 3:53
  comorbidities,
• 3:54
  they
• 3:54
  might
• 3:54
  have
• 3:55
  a
• 3:55
  different
• 3:55
  diet,
• 3:56
  they
• 3:56
  might
• 3:56
  have
• 3:56
  different
• 3:56
  attitudes
• 3:57
  towards
• 3:57
  mental
• 3:57
  health
• 3:57
  care,
• 3:58
  and
• 3:58
  they
• 3:58
  have
• 3:59
  prostate
• 3:59
  cancer,
• 3:59
  which
• 4:00
  is
• 4:00
  even
• 4:00
  more
• 4:00
  of
• 4:00
  a
• 4:00
  confounding
• 4:01
  variable.
• 4:02
  So
• 4:02
  when
• 4:02
  you
• 4:02
  look
• 4:03
  at
• 4:03
  a
• 4:03
  study,
• 4:03
  ask
• 4:03
  yourself,
• 4:04
  is
• 4:04
  there
• 4:04
  overlap
• 4:05
  between
• 4:05
  who
• 4:05
  they're
• 4:06
  studying
• 4:06
  and
• 4:06
  who
• 4:06
  I
• 4:07
  see?
• 4:07
  Right.
• 4:08
  If
• 4:08
  this
• 4:08
  study
• 4:09
  was
• 4:09
  about
• 4:10
  65
• 4:11
  year
• 4:11
  olds
• 4:12
  with
• 4:12
  schizoaffective
• 4:13
  disorder,
• 4:13
  that's
• 4:14
  not
• 4:14
  necessarily
• 4:15
  relevant
• 4:15
  to
• 4:16
  you
• 4:16
  if
• 4:16
  85%
• 4:17
  of
• 4:17
  your
• 4:17
  patients
• 4:18
  are
• 4:19
  bipolar
• 4:20
  or
• 4:21
  depressed
• 4:22
  or
• 4:22
  ADHD.
• 4:23
  Right.
• 4:24
  And
• 4:25
  I
• 4:25
  don't
• 4:25
  mean
• 4:25
  to
• 4:25
  beat
• 4:25
  the
• 4:25
  dead
• 4:26
  horse
• 4:26
  here,
• 4:26
  my
• 4:26
  friends,
• 4:27
  but
• 4:27
  the
• 4:27
  point
• 4:28
  is
• 4:28
  it's
• 4:28
  very
• 4:29
  important
• 4:29
  that
• 4:30
  who
• 4:30
  they're
• 4:30
  studying
• 4:31
  is,
• 4:31
  are
• 4:31
  the
• 4:32
  same
• 4:32
  patients
• 4:32
  that
• 4:32
  you're
• 4:32
  seeing.
• 4:33
  Okay.
• 4:34
  And
• 4:34
  also
• 4:34
  you
• 4:35
  want
• 4:35
  to
• 4:35
  look
• 4:35
  at
• 4:35
  the
• 4:35
  outcome
• 4:35
  measure
• 4:36
  in
• 4:36
  this
• 4:36
  journal
• 4:37
  article,
• 4:37
  the
• 4:37
  outcome
• 4:38
  measure,
• 4:38
  or
• 4:39
  in
• 4:39
  this
• 4:39
  research
• 4:39
  study.
• 4:39
  The
• 4:40
  outcome
• 4:40
  measure
• 4:40
  was
• 4:41
  the
• 4:41
  number
• 4:41
  of
• 4:42
  participants
• 4:42
  who
• 4:42
  responded
• 4:43
  to
• 4:43
  treatment.
• 4:44
  And
• 4:44
  that
• 4:44
  response
• 4:45
  is
• 4:45
  a
• 4:45
  very
• 4:46
  defined
• 4:47
  definition.
• 4:48
  It's
• 4:48
  not
• 4:48
  just
• 4:49
  who
• 4:49
  responded
• 4:50
  to
• 4:50
  treatment.
• 4:50
  It's
• 4:50
  showing
• 4:51
  a
• 4:51
  reduction
• 4:51
  in
• 4:52
  50%
• 4:53
  of
• 4:53
  the
• 4:53
  Hamilton
• 4:54
  Depression
• 4:54
  Scale
• 4:54
  scores
• 4:55
  or
• 4:56
  the
• 4:56
  MADRS.
• 4:57
  These
• 4:57
  are
• 4:57
  valid
• 4:58
  empirically
• 4:59
  tested
• 4:59
  depression
• 5:00
  scales.
• 5:01
  And
• 5:01
  a
• 5:01
  50%
• 5:01
  reduction
• 5:02
  is
• 5:02
  defined
• 5:03
  as
• 5:03
  a
• 5:03
  response
• 5:03
  or
• 5:04
  the
• 5:04
  primary
• 5:04
  outcome
• 5:04
  measure
• 5:05
  in
• 5:05
  the
• 5:05
  study.
• 5:06
  The
• 5:06
  secondary
• 5:06
  outcome
• 5:07
  measure
• 5:07
  was
• 5:07
  the
• 5:07
  number
• 5:07
  of
• 5:07
  participants
• 5:08
  who
• 5:08
  achieved
• 5:08
  remission,
• 5:09
  a
• 5:10
  near
• 5:10
  elimination
• 5:10
  of
• 5:11
  depressive
• 5:11
  symptoms.
• 5:12
  These
• 5:12
  are
• 5:12
  very
• 5:13
  good
• 5:13
  outcome
• 5:14
  measures.
• 5:14
  When
• 5:14
  you're
• 5:14
  looking
• 5:14
  at
• 5:15
  an
• 5:15
  article,
• 5:15
  you
• 5:15
  have
• 5:15
  to
• 5:16
  make
• 5:16
  sure
• 5:17
  that
• 5:17
  the
• 5:17
  outcome
• 5:17
  measures
• 5:18
  are
• 5:18
  relevant
• 5:18
  because
• 5:18
  if
• 5:19
  the
• 5:19
  outcome
• 5:19
  measures
• 5:19
  said,
• 5:20
  well,
• 5:20
  we
• 5:21
  measured
• 5:21
  the
• 5:21
  efficacy
• 5:22
  of
• 5:22
  Lexapro
• 5:23
  based
• 5:23
  on
• 5:25
  how
• 5:25
  well
• 5:25
  a
• 5:26
  patient
• 5:27
  was
• 5:27
  able
• 5:27
  to
• 5:28
  sleep
• 5:29
  or
• 5:29
  how
• 5:30
  regularized
• 5:30
  their
• 5:30
  appetite
• 5:31
  was
• 5:31
  following
• 5:31
  the
• 5:32
  study.
• 5:33
  That's
• 5:33
  kind
• 5:33
  of
• 5:33
  murky.
• 5:34
  That's
• 5:34
  not
• 5:34
  exactly
• 5:35
  specific
• 5:35
  to
• 5:36
  depression.
• 5:37
  That
• 5:37
  might
• 5:37
  have
• 5:37
  a
• 5:38
  lot
• 5:38
  of
• 5:38
  confounding
• 5:39
  variables
• 5:39
  attached
• 5:39
  to
• 5:40
  it.
• 5:40
  And
• 5:40
  is
• 5:41
  that
• 5:41
  really
• 5:41
  going
• 5:42
  to
• 5:42
  make
• 5:42
  or
• 5:42
  break
• 5:43
  your
• 5:43
  patients
• 5:43
  in
• 5:43
  clinic?
• 5:44
  I
• 5:44
  mean,
• 5:44
  you
• 5:44
  want
• 5:45
  to
• 5:45
  drop
• 5:45
  their
• 5:45
  depression
• 5:46
  scores,
• 5:46
  right?
• 5:47
  You
• 5:47
  want
• 5:47
  a
• 5:48
  meaningful
• 5:48
  outcome,
• 5:49
  not
• 5:49
  just
• 5:49
  with
• 5:49
  respect
• 5:50
  to
• 5:50
  your
• 5:50
  metrics,
• 5:51
  but
• 5:51
  also
• 5:52
  their
• 5:52
  general
• 5:53
  symptoms
• 5:53
  and
• 5:53
  who
• 5:54
  they
• 5:54
  are
• 5:54
  and
• 5:54
  what
• 5:54
  they're
• 5:55
  striving
• 5:55
  for.
• 5:55
  So
• 5:55
  be
• 5:56
  picky
• 5:56
  with
• 5:57
  the
• 5:57
  primary
• 5:57
  and
• 5:57
  secondary
• 5:58
  outcome
• 5:58
  measures
• 5:58
  of
• 5:59
  a
• 5:59
  study.
• 5:59
  Make
• 6:00
  sure
• 6:00
  that
• 6:00
  whatever
• 6:01
  the
• 6:01
  study's
• 6:01
  trying
• 6:02
  to
• 6:02
  tell
• 6:02
  you
• 6:02
  is
• 6:02
  studying
• 6:03
  the
• 6:03
  people
• 6:03
  that
• 6:03
  are
• 6:04
  relevant
• 6:04
  to
• 6:04
  you
• 6:04
  and
• 6:05
  the
• 6:05
  outcome
• 6:05
  measures
• 6:06
  are
• 6:07
  actually
• 6:07
  meaningful
• 6:08
  for
• 6:08
  your
• 6:08
  practice.
• 6:08
  And
• 6:08
  in
• 6:09
  this
• 6:09
  case,
• 6:09
  I
• 6:09
  would
• 6:09
  say
• 6:09
  they
• 6:10
  very
• 6:10
  much
• 6:10
  are.
• 6:10
  Remission
• 6:11
  and
• 6:11
  response
• 6:11
  is
• 6:12
  the
• 6:12
  meat
• 6:12
  and
• 6:12
  potatoes
• 6:13
  of
• 6:13
  what
• 6:13
  we're
• 6:13
  chasing
• 6:14
  in
• 6:14
  the
• 6:14
  outpatient
• 6:15
  space.
• 6:15
  The
• 6:15
  results
• 6:16
  of
• 6:16
  this
• 6:16
  study
• 6:16
  showed
• 6:17
  that
• 6:17
  Escitalopram
• 6:18
  Lexapro
• 6:19
  was
• 6:19
  significantly
• 6:20
  more
• 6:20
  effective
• 6:20
  than
• 6:20
  Celexa
• 6:21
  in
• 6:21
  achieving
• 6:22
  an
• 6:22
  acute
• 6:22
  response,
• 6:23
  defined
• 6:24
  by
• 6:24
  how
• 6:24
  the
• 6:24
  patient
• 6:25
  felt
• 6:25
  a
• 6:25
  difference
• 6:26
  in
• 6:26
  the
• 6:26
  first
• 6:26
  six
• 6:27
  to
• 6:27
  12
• 6:27
  weeks
• 6:27
  of
• 6:28
  treatment.
• 6:28
  And
• 6:29
  what
• 6:29
  was
• 6:29
  particularly
• 6:30
  interesting
• 6:30
  is
• 6:31
  that
• 6:31
  the
• 6:31
  acceptability
• 6:31
  and
• 6:32
  tolerability
• 6:32
  of
• 6:33
  Lexapro
• 6:33
  was
• 6:34
  what
• 6:34
  really
• 6:34
  shined
• 6:34
  here.
• 6:35
  And
• 6:35
  this
• 6:36
  is
• 6:36
  something
• 6:36
  that
• 6:37
  you
• 6:37
  should
• 6:37
  all
• 6:37
  think
• 6:38
  about
• 6:38
  as
• 6:38
  you
• 6:39
  navigate
• 6:39
  your
• 6:40
  unique
• 6:40
  prescribing
• 6:41
  philosophies
• 6:42
  moving
• 6:42
  forward.
• 6:43
  There
• 6:43
  are
• 6:43
  a
• 6:43
  lot
• 6:43
  of
• 6:44
  job
• 6:44
  interviews
• 6:44
  out
• 6:44
  there
• 6:44
  that
• 6:45
  are
• 6:45
  going
• 6:45
  to
• 6:45
  ask
• 6:45
  you
• 6:46
  point
• 6:46
  blank,
• 6:46
  as
• 6:46
  a
• 6:46
  new
• 6:47
  grad,
• 6:47
  what's
• 6:47
  your
• 6:48
  prescribing
• 6:48
  philosophy?
• 6:50
  And
• 6:50
  rather
• 6:50
  than
• 6:51
  scream
• 6:51
  and
• 6:51
  run
• 6:51
  out
• 6:52
  of
• 6:52
  the
• 6:52
  room,
• 6:53
  it's
• 6:53
  important
• 6:53
  that
• 6:53
  you
• 6:54
  can
• 6:54
  articulate
• 6:55
  what
• 6:55
  your
• 6:55
  philosophy
• 6:56
  is.
• 6:56
  I
• 6:57
  think
• 6:57
  Lexapro
• 6:58
  is
• 6:58
  one
• 6:58
  of
• 6:58
  those
• 6:58
  medications
• 6:59
  that
• 6:59
  makes
• 7:00
  me
• 7:00
  pause
• 7:00
  and
• 7:00
  think,
• 7:01
  yeah,
• 7:01
  maybe
• 7:01
  I
• 7:02
  should
• 7:02
  gravitate
• 7:03
  towards
• 7:03
  that
• 7:03
  medication
• 7:04
  a
• 7:04
  lot
• 7:04
  more.
• 7:04
  Not
• 7:04
  only
• 7:04
  because
• 7:05
  the
• 7:05
  evidence
• 7:05
  suggests
• 7:06
  it's
• 7:06
  generally
• 7:06
  more
• 7:07
  acceptable
• 7:07
  and
• 7:07
  tolerable
• 7:08
  during
• 7:08
  the
• 7:09
  acute
• 7:09
  phase
• 7:09
  of
• 7:09
  treatment.
• 7:10
  That's
• 7:10
  the
• 7:10
  first
• 7:10
  six
• 7:10
  to
• 7:11
  12
• 7:11
  weeks.
• 7:11
  If
• 7:11
  a
• 7:11
  medication
• 7:12
  is
• 7:12
  more
• 7:12
  acceptable
• 7:13
  and
• 7:13
  tolerable,
• 7:14
  doesn't
• 7:14
  that
• 7:14
  also
• 7:14
  mean
• 7:15
  it
• 7:15
  could
• 7:15
  very
• 7:15
  well
• 7:16
  be
• 7:16
  more
• 7:16
  efficacious?
• 7:17
  Here's
• 7:17
  a
• 7:17
  perfect
• 7:17
  analogy
• 7:18
  for
• 7:18
  you,
• 7:19
  okay?
• 7:19
  You
• 7:20
  know,
• 7:20
  I
• 7:20
  love
• 7:20
  analogies,
• 7:21
  my
• 7:21
  friends.
• 7:22
  And
• 7:23
  if
• 7:23
  I
• 7:23
  told
• 7:24
  you,
• 7:24
  or
• 7:25
  let's
• 7:25
  say
• 7:25
  if,
• 7:25
  there
• 7:25
  was
• 7:26
  a
• 7:26
  study
• 7:26
  that
• 7:26
  came
• 7:26
  out
• 7:27
  tomorrow
• 7:27
  that
• 7:27
  said
• 7:28
  bananas
• 7:29
  and
• 7:29
  Brussels
• 7:30
  sprouts
• 7:31
  both
• 7:31
  reduce
• 7:32
  heart
• 7:33
  attack
• 7:33
  risk,
• 7:34
  okay?
• 7:35
  The
• 7:35
  risk
• 7:35
  that
• 7:35
  you
• 7:36
  will
• 7:36
  have
• 7:36
  a
• 7:36
  heart
• 7:36
  attack
• 7:36
  will
• 7:37
  go
• 7:37
  down
• 7:37
  50%
• 7:38
  if
• 7:38
  you
• 7:38
  eat
• 7:38
  bananas
• 7:39
  or
• 7:39
  you
• 7:39
  eat
• 7:40
  Brussels
• 7:40
  sprouts
• 7:40
  on
• 7:41
  a
• 7:41
  regular
• 7:41
  basis.
• 8:37
  Now,
• 8:37
  that
• 8:37
  might
• 8:37
  be
• 8:37
  an
• 8:38
  exciting
• 8:38
  statistic
• 8:39
  for
• 8:40
  people,
• 8:41
  but
• 8:41
  if
• 8:41
  you
• 8:41
  hate
• 8:41
  Brussels
• 8:42
  sprouts
• 8:42
  like
• 8:42
  I
• 8:43
  do,
• 8:43
  and
• 8:43
  you
• 8:44
  need
• 8:44
  to
• 8:44
  either
• 8:44
  deep
• 8:45
  fry
• 8:45
  them
• 8:45
  Dunk
• 8:46
  them
• 8:46
  in
• 8:46
  chocolate
• 8:47
  or
• 8:48
  ranch
• 8:49
  dressing
• 8:50
  or
• 8:51
  oven
• 8:51
  roast
• 8:51
  them
• 8:52
  and
• 8:52
  douse
• 8:52
  them
• 8:52
  in
• 8:54
  olive
• 8:54
  oil
• 8:55
  and
• 8:55
  Parmesan
• 8:56
  cheese
• 8:56
  and
• 8:56
  pepper
• 8:57
  and
• 8:57
  season
• 8:57
  the
• 8:58
  absolute
• 9:01
  you
• 9:01
  know
• 9:01
  what
• 9:01
  out
• 9:02
  of
• 9:02
  it
• 9:02
  to
• 9:02
  make
• 9:03
  it
• 9:03
  taste
• 9:03
  good.
• 9:04
  If
• 9:04
  you
• 9:04
  have
• 9:04
  to
• 9:04
  do
• 9:04
  that,
• 9:05
  well,
• 9:06
  how
• 9:06
  many
• 9:06
  people
• 9:06
  are
• 9:06
  reasonably
• 9:07
  going
• 9:07
  to
• 9:07
  eat
• 9:07
  Brussel
• 9:08
  sprouts
• 9:08
  every
• 9:08
  day?
• 9:09
  Even
• 9:09
  if
• 9:09
  it
• 9:10
  reduces
• 9:10
  heart
• 9:10
  attack
• 9:11
  risk?
• 9:11
  Most
• 9:11
  people
• 9:12
  are
• 9:12
  eating
• 9:12
  McDonald's.
• 9:13
  We
• 9:13
  already
• 9:13
  know
• 9:14
  that
• 9:14
  Brussels
• 9:15
  sprouts
• 9:15
  are
• 9:16
  fantastically
• 9:16
  good
• 9:16
  for
• 9:17
  us,
• 9:17
  and
• 9:17
  yet
• 9:17
  99%
• 9:18
  of
• 9:18
  us
• 9:19
  don't
• 9:19
  even
• 9:19
  want
• 9:20
  to
• 9:20
  look
• 9:20
  at
• 9:20
  them
• 9:21
  on
• 9:21
  the
• 9:21
  supermarket
• 9:22
  shelves
• 9:22
  without
• 9:23
  getting
• 9:23
  nauseous.
• 9:24
  Your
• 9:24
  medications
• 9:25
  are
• 9:25
  not
• 9:25
  that
• 9:25
  different
• 9:26
  in
• 9:26
  some
• 9:26
  sense.
• 9:27
  You
• 9:27
  might
• 9:27
  see
• 9:28
  in
• 9:28
  your
• 9:28
  textbooks
• 9:29
  this
• 9:29
  amazing
• 9:30
  effect
• 9:30
  size
• 9:30
  with
• 9:31
  a
• 9:31
  particular
• 9:31
  medication.
• 9:32
  You
• 9:32
  might
• 9:32
  see
• 9:33
  all
• 9:33
  these
• 9:33
  really
• 9:33
  cool
• 9:34
  receptor
• 9:35
  targets
• 9:35
  and
• 9:36
  the
• 9:36
  affinity
• 9:36
  it
• 9:37
  has
• 9:37
  for
• 9:37
  specific
• 9:37
  receptors.
• 9:38
  It
• 9:38
  blocks
• 9:39
  the
• 9:39
  5ht2c
• 9:40
  receptor.
• 9:40
  Therefore,
• 9:41
  it
• 9:41
  increases
• 9:41
  dopamine
• 9:42
  and
• 9:42
  norepinephrine
• 9:43
  in
• 9:43
  the
• 9:43
  prefrontal
• 9:43
  cortex.
• 9:44
  That's
• 9:44
  great
• 9:44
  for
• 9:45
  people.
• 9:45
  They
• 9:45
  can
• 9:45
  focus
• 9:45
  better.
• 9:46
  They
• 9:46
  have
• 9:47
  a
• 9:47
  little
• 9:47
  more
• 9:47
  energy
• 9:47
  in
• 9:47
  the
• 9:47
  morning.
• 9:48
  I
• 9:48
  love
• 9:48
  Prozac.
• 9:49
  It's
• 9:49
  great.
• 9:49
  Look
• 9:50
  how
• 9:50
  different
• 9:50
  it
• 9:50
  is.
• 9:50
  Zoloft
• 9:51
  has
• 9:51
  some
• 9:51
  sigma
• 9:52
  activity
• 9:53
  attached
• 9:53
  to
• 9:53
  it.
• 9:53
  Like,
• 9:54
  that's
• 9:54
  really
• 9:54
  cool,
• 9:54
  Luvox.
• 9:55
  These
• 9:55
  are
• 9:55
  all
• 9:56
  cool
• 9:56
  receptors.
• 9:56
  Look
• 9:57
  what
• 9:57
  I
• 9:57
  can
• 9:57
  do.
• 9:58
  That's
• 9:58
  all
• 9:58
  great,
• 9:58
  my
• 9:59
  friends,
• 9:59
  but
• 10:00
  if
• 10:00
  you're
• 10:01
  trying
• 10:01
  to
• 10:01
  give
• 10:01
  your
• 10:02
  patient
• 10:02
  a
• 10:02
  Brussels
• 10:02
  sprout
• 10:03
  and
• 10:03
  they
• 10:03
  hate
• 10:03
  Brussels
• 10:04
  sprouts,
• 10:04
  it
• 10:04
  doesn't
• 10:05
  really
• 10:05
  matter
• 10:06
  that
• 10:07
  the
• 10:07
  Brussels
• 10:08
  sprout
• 10:08
  is
• 10:08
  good
• 10:09
  at
• 10:09
  reducing
• 10:09
  heart
• 10:09
  attacks.
• 10:10
  What
• 10:10
  matters
• 10:11
  is
• 10:11
  you're
• 10:11
  setting
• 10:12
  your
• 10:12
  patient
• 10:12
  up
• 10:12
  with
• 10:13
  a
• 10:13
  medication
• 10:13
  they
• 10:13
  can
• 10:14
  reliably
• 10:14
  take.
• 10:15
  It's
• 10:15
  acceptable
• 10:16
  and
• 10:16
  tolerable
• 10:16
  to
• 10:16
  them.
• 10:17
  Acceptable
• 10:18
  in
• 10:18
  that
• 10:18
  it
• 10:18
  benefits
• 10:19
  them,
• 10:19
  they
• 10:19
  feel
• 10:19
  better
• 10:19
  and
• 10:20
  they
• 10:20
  stay
• 10:20
  on
• 10:20
  the
• 10:20
  medication.
• 10:21
  Tolerable
• 10:22
  to
• 10:22
  them
• 10:22
  in
• 10:22
  that
• 10:22
  it
• 10:23
  doesn't
• 10:24
  cause
• 10:24
  side
• 10:24
  effects
• 10:24
  that
• 10:25
  make
• 10:25
  them
• 10:25
  drop
• 10:25
  out.
• 10:25
  And
• 10:26
  this
• 10:26
  study
• 10:26
  sure
• 10:26
  enough
• 10:27
  saw
• 10:27
  that
• 10:28
  if
• 10:28
  you
• 10:28
  took
• 10:28
  lexapro,
• 10:29
  you
• 10:29
  were
• 10:29
  7%
• 10:29
  less
• 10:30
  likely
• 10:30
  to
• 10:30
  quit
• 10:30
  due
• 10:31
  to
• 10:31
  side
• 10:31
  effects
• 10:31
  compared
• 10:32
  to
• 10:32
  other
• 10:32
  SSRIs.
• 10:33
  Well,
• 10:33
  that's
• 10:34
  a
• 10:34
  big
• 10:34
  deal
• 10:34
  because
• 10:35
  again,
• 10:36
  for
• 10:36
  folks
• 10:36
  that
• 10:38
  want
• 10:38
  their
• 10:38
  heart
• 10:38
  attack
• 10:39
  risk
• 10:39
  to
• 10:39
  go
• 10:39
  down,
• 10:40
  I
• 10:40
  think
• 10:41
  a
• 10:41
  banana
• 10:41
  is
• 10:41
  probably
• 10:42
  safer.
• 10:42
  Banana
• 10:42
  goes
• 10:43
  down
• 10:43
  easy,
• 10:43
  it's
• 10:43
  soft.
• 10:44
  It's
• 10:44
  not
• 10:44
  as
• 10:44
  offensive
• 10:45
  as
• 10:45
  a
• 10:45
  Brussels
• 10:45
  sprout.
• 10:45
  You
• 10:46
  can
• 10:46
  make
• 10:46
  smoothies
• 10:46
  out
• 10:47
  of
• 10:47
  it.
• 10:48
  And
• 10:48
  that's
• 10:48
  my
• 10:49
  point,
• 10:49
  my
• 10:49
  friend.
• 10:49
  If
• 10:49
  you're
• 10:50
  stuck
• 10:50
  between
• 10:50
  two
• 10:50
  medications,
• 10:51
  you
• 10:51
  have
• 10:51
  to
• 10:52
  think
• 10:52
  a
• 10:52
  little
• 10:52
  more
• 10:53
  deeply.
• 10:54
  What
• 10:54
  receptor
• 10:54
  targets
• 10:55
  am
• 10:56
  I
• 10:56
  looking
• 10:56
  at?
• 10:56
  That's
• 10:57
  very
• 10:57
  important.
• 10:57
  But
• 10:58
  at
• 10:58
  the
• 10:58
  end
• 10:58
  of
• 10:58
  the
• 10:58
  day,
• 10:59
  you
• 10:59
  also
• 10:59
  have
• 10:59
  to
• 10:59
  ask
• 11:00
  yourself,
• 11:00
  is
• 11:00
  this
• 11:00
  tolerable?
• 11:01
  Is
• 11:01
  this
• 11:01
  acceptable
• 11:02
  to
• 11:02
  the
• 11:02
  patient?
• 11:03
  What's
• 11:03
  going
• 11:03
  to
• 11:03
  happen
• 11:04
  if
• 11:05
  the
• 11:05
  patient
• 11:05
  gets
• 11:06
  really
• 11:06
  nauseous
• 11:06
  on
• 11:06
  this
• 11:07
  other
• 11:07
  medication.
• 11:08
  What's
• 11:08
  going
• 11:08
  to
• 11:08
  happen
• 11:08
  if
• 11:09
  the
• 11:09
  patient
• 11:09
  gains
• 11:09
  weight
• 11:10
  on
• 11:10
  Paxil
• 11:10
  or
• 11:11
  has
• 11:11
  dry
• 11:11
  mouth
• 11:11
  or
• 11:12
  has
• 11:12
  constipation?
• 11:13
  We
• 11:14
  have
• 11:14
  to
• 11:14
  think
• 11:14
  about
• 11:14
  these
• 11:15
  things
• 11:15
  and
• 11:15
  put
• 11:16
  them
• 11:16
  through
• 11:16
  a
• 11:16
  filter
• 11:17
  every
• 11:17
  time
• 11:17
  we
• 11:17
  make
• 11:18
  a
• 11:18
  choice
• 11:18
  to
• 11:18
  prescribe,
• 11:19
  because
• 11:19
  it's
• 11:19
  not
• 11:20
  as
• 11:20
  simple
• 11:20
  as
• 11:20
  the
• 11:20
  evidence
• 11:21
  shows
• 11:21
  this,
• 11:21
  and
• 11:22
  therefore
• 11:22
  you
• 11:22
  need
• 11:22
  to
• 11:22
  do
• 11:23
  it.
• 11:23
  This
• 11:23
  receptor
• 11:25
  is,
• 11:25
  you
• 11:25
  know,
• 11:25
  this
• 11:26
  medication
• 11:26
  targets
• 11:27
  this
• 11:27
  receptor.
• 11:27
  And
• 11:27
  how
• 11:28
  elegant,
• 11:28
  how
• 11:28
  perfect.
• 11:28
  Let's
• 11:29
  do
• 11:29
  it.
• 11:30
  Is
• 11:30
  your
• 11:30
  patient
• 11:31
  medication
• 11:31
  naive?
• 11:32
  They
• 11:32
  might
• 11:32
  be
• 11:33
  hesitant
• 11:34
  to
• 11:34
  go
• 11:34
  with
• 11:34
  something
• 11:35
  like
• 11:35
  Paxil
• 11:36
  or
• 11:36
  Effexor,
• 11:37
  where
• 11:37
  if
• 11:37
  you
• 11:37
  miss
• 11:37
  a
• 11:37
  dose
• 11:38
  on
• 11:38
  accident,
• 11:38
  you
• 11:38
  have
• 11:39
  a
• 11:39
  little
• 11:39
  bit
• 11:39
  of
• 11:39
  a
• 11:39
  withdrawal
• 11:40
  that's
• 11:40
  unpleasant.
• 11:40
  The
• 11:41
  Paxil
• 11:41
  side
• 11:41
  effects
• 11:42
  could
• 11:42
  spook
• 11:43
  someone
• 11:43
  who's
• 11:43
  otherwise
• 11:44
  already
• 11:44
  wary
• 11:44
  of
• 11:45
  medications.
• 11:45
  And
• 11:46
  this
• 11:46
  study
• 11:47
  seems
• 11:47
  to
• 11:47
  suggest
• 11:48
  that
• 11:48
  folks
• 11:49
  on
• 11:49
  Lexapro
• 11:49
  were
• 11:50
  33%
• 11:50
  more
• 11:50
  likely
• 11:51
  to
• 11:51
  get
• 11:51
  noticeably
• 11:52
  better
• 11:52
  than
• 11:52
  people
• 11:52
  on
• 11:52
  Celexa.
• 11:53
  More
• 11:54
  people
• 11:54
  went
• 11:54
  into
• 11:54
  remission
• 11:55
  on
• 11:55
  Escitalopram
• 11:56
  or
• 11:56
  Lexapro,
• 11:57
  and
• 11:58
  that's
• 11:58
  pretty
• 11:58
  great.
• 11:59
  I
• 11:59
  mean,
• 12:00
  roughly
• 12:00
  twice
• 12:00
  as
• 12:01
  likely
• 12:01
  to
• 12:01
  have
• 12:02
  their
• 12:02
  depression
• 12:02
  go
• 12:03
  into
• 12:03
  full
• 12:03
  remission.
• 12:04
  So
• 12:04
  the
• 12:04
  Lexapro
• 12:05
  group
• 12:06
  had
• 12:06
  folks
• 12:06
  roughly
• 12:07
  twice
• 12:07
  as
• 12:07
  likely
• 12:07
  to
• 12:08
  have
• 12:08
  their
• 12:08
  depression
• 12:09
  go
• 12:09
  into
• 12:09
  remission.
• 12:11
  So
• 12:11
  that's
• 12:11
  a
• 12:11
  big
• 12:11
  deal.
• 12:12
  Right?
• 12:12
  And
• 12:12
  it's
• 12:12
  a
• 12:13
  big
• 12:13
  deal
• 12:13
  if
• 12:13
  a
• 12:14
  lot
• 12:14
  of
• 12:14
  this
• 12:14
  has
• 12:14
  to
• 12:14
  do
• 12:14
  with
• 12:15
  adherence
• 12:15
  and
• 12:15
  tolerability,
• 12:16
  that
• 12:16
  the
• 12:17
  patients
• 12:17
  are
• 12:17
  regularly
• 12:18
  eating
• 12:18
  a
• 12:18
  banana
• 12:19
  every
• 12:19
  day,
• 12:20
  so
• 12:20
  to
• 12:20
  speak,
• 12:21
  because
• 12:21
  it's
• 12:21
  tolerable,
• 12:22
  because
• 12:22
  it
• 12:22
  doesn't
• 12:22
  cause
• 12:23
  them
• 12:23
  to
• 12:23
  drop
• 12:23
  out.
• 12:24
  They're
• 12:24
  having
• 12:24
  less
• 12:24
  heart
• 12:25
  attacks.
• 12:25
  So
• 12:25
  it's
• 12:25
  the
• 12:25
  same
• 12:25
  kind
• 12:26
  of
• 12:26
  principle.
• 12:27
  And
• 12:28
  I
• 12:28
  think
• 12:28
  for
• 12:28
  that
• 12:28
  reason,
• 12:28
  this
• 12:29
  is
• 12:29
  very
• 12:29
  exciting.
• 12:30
  Remember
• 12:30
  that
• 12:30
  Lexapro
• 12:32
  has
• 12:33
  minimal.
• 12:35
  It's
• 12:35
  kind
• 12:35
  of
• 12:35
  a
• 12:36
  no
• 12:36
  drama
• 12:37
  medication.
• 12:38
  It
• 12:38
  doesn't
• 12:38
  mess
• 12:38
  with
• 12:39
  histamine
• 12:39
  or
• 12:39
  the
• 12:40
  muscarinic
• 12:40
  receptors.
• 12:41
  So
• 12:42
  it's
• 12:42
  not
• 12:42
  making
• 12:42
  you
• 12:42
  drowsy
• 12:43
  or
• 12:43
  tired
• 12:43
  or
• 12:44
  giving
• 12:44
  you
• 12:44
  dry
• 12:45
  mouth
• 12:45
  or
• 12:45
  constipation.
• 12:46
  It's
• 12:46
  a
• 12:46
  clean.
• 12:47
  It's
• 12:48
  a
• 12:48
  clean
• 12:49
  ssri.
• 12:50
  Right.
• 12:50
  It
• 12:51
  blocks
• 12:51
  the
• 12:51
  reuptake
• 12:52
  of
• 12:52
  serotonin
• 12:53
  and
• 12:53
  it
• 12:53
  has
• 12:53
  a
• 12:53
  very
• 12:53
  high
• 12:54
  affinity
• 12:54
  for
• 12:54
  that
• 12:55
  SIRT
• 12:55
  transporter,
• 12:56
  the
• 12:56
  highest
• 12:56
  affinity
• 12:57
  of
• 12:57
  all
• 12:57
  the
• 12:57
  SSRIs.
• 12:58
  Okay,
• 12:59
  so
• 12:59
  it's
• 12:59
  doing
• 12:59
  a
• 13:00
  clean,
• 13:00
  laser
• 13:01
  focused
• 13:01
  thing
• 13:01
  in
• 13:01
  that
• 13:02
  it
• 13:02
  blocks
• 13:02
  the
• 13:02
  reuptake
• 13:03
  of
• 13:03
  serotonin,
• 13:04
  making
• 13:04
  it
• 13:04
  more
• 13:04
  available
• 13:04
  in
• 13:05
  the
• 13:05
  synapse.
• 13:06
  And
• 13:06
  there's
• 13:06
  not
• 13:06
  a
• 13:06
  lot
• 13:07
  of
• 13:07
  other
• 13:07
  drama
• 13:07
  associated
• 13:08
  with
• 13:08
  it
• 13:08
  as
• 13:08
  opposed
• 13:09
  to
• 13:09
  a
• 13:09
  lot
• 13:10
  of
• 13:10
  these
• 13:10
  other
• 13:10
  SSRIs,
• 13:11
  but
• 13:11
  they
• 13:12
  seem
• 13:12
  to
• 13:12
  be
• 13:13
  opening
• 13:13
  different
• 13:13
  doors
• 13:14
  that
• 13:14
  Lexapro
• 13:15
  doesn't
• 13:15
  open
• 13:16
  and
• 13:16
  thus
• 13:17
  causing
• 13:17
  more
• 13:18
  side
• 13:18
  effects.
• 13:19
  And
• 13:19
  so
• 13:20
  if
• 13:20
  side
• 13:20
  Effects
• 13:21
  are
• 13:21
  going
• 13:21
  to
• 13:21
  be
• 13:21
  a
• 13:21
  deal
• 13:21
  breaker.
• 13:22
  That
• 13:22
  means
• 13:23
  your
• 13:23
  patient
• 13:23
  may
• 13:24
  not
• 13:24
  take
• 13:24
  the
• 13:24
  medication
• 13:25
  consistently
• 13:26
  enough
• 13:26
  to
• 13:26
  achieve
• 13:27
  a
• 13:27
  therapeutic
• 13:28
  serum
• 13:28
  level
• 13:29
  often
• 13:29
  enough
• 13:30
  to
• 13:30
  break
• 13:30
  these
• 13:31
  depressive
• 13:31
  symptoms
• 13:31
  or
• 13:32
  these
• 13:32
  anxiety
• 13:32
  symptoms.
• 13:33
  And
• 13:33
  that's
• 13:33
  a
• 13:33
  big
• 13:33
  deal,
• 13:34
  right?
• 13:34
  Because
• 13:34
  what
• 13:34
  good
• 13:34
  is
• 13:35
  your
• 13:35
  medication
• 13:35
  if
• 13:35
  it
• 13:36
  can't
• 13:36
  be
• 13:36
  taken
• 13:37
  frequently?
• 13:38
  And
• 13:38
  that's
• 13:38
  really
• 13:38
  the
• 13:39
  main
• 13:39
  point.
• 13:40
  What
• 13:40
  good
• 13:40
  is
• 13:41
  your
• 13:41
  medication
• 13:41
  if
• 13:41
  people
• 13:42
  aren't
• 13:42
  gonna
• 13:42
  take
• 13:42
  it?
• 13:42
  You
• 13:43
  have
• 13:43
  to
• 13:43
  really
• 13:44
  warn
• 13:44
  patients.
• 13:44
  If
• 13:45
  you're
• 13:45
  gonna
• 13:45
  go
• 13:45
  down
• 13:46
  these
• 13:46
  other
• 13:46
  roads
• 13:47
  with
• 13:47
  other
• 13:47
  meds,
• 13:48
  that's
• 13:48
  perfectly
• 13:48
  fine.
• 13:48
  They
• 13:49
  can
• 13:49
  be
• 13:49
  wonderful
• 13:49
  medications,
• 13:50
  including
• 13:50
  Paxil.
• 13:51
  You
• 13:52
  wanna
• 13:52
  advise
• 13:52
  them
• 13:53
  and
• 13:53
  say,
• 13:53
  hey,
• 13:53
  this
• 13:53
  is
• 13:53
  what
• 13:53
  you
• 13:54
  wanna
• 13:54
  look
• 13:54
  out
• 13:54
  for.
• 13:54
  If
• 13:55
  they're
• 13:55
  more
• 13:55
  prepared
• 13:55
  for
• 13:56
  that,
• 13:56
  they're
• 13:56
  not
• 13:56
  as
• 13:56
  surprised,
• 13:57
  they're
• 13:57
  not
• 13:57
  as
• 13:57
  scared.
• 13:58
  There's
• 13:58
  not
• 13:58
  the
• 13:59
  uncertainty
• 13:59
  of,
• 13:59
  oh,
• 13:59
  my
• 14:00
  God,
• 14:00
  should
• 14:00
  I
• 14:00
  be
• 14:00
  feeling
• 14:01
  this
• 14:01
  right
• 14:01
  now?
• 14:01
  Is
• 14:01
  this
• 14:01
  an
• 14:02
  emergency?
• 14:02
  Is
• 14:03
  this
• 14:03
  gonna
• 14:03
  be
• 14:03
  permanent?
• 14:04
  You're
• 14:04
  giving
• 14:04
  them
• 14:04
  that
• 14:05
  anticipatory
• 14:05
  guidance
• 14:06
  that
• 14:06
  is
• 14:06
  important
• 14:07
  so
• 14:07
  that
• 14:07
  they're
• 14:07
  able
• 14:08
  to
• 14:08
  navigate
• 14:08
  these
• 14:08
  problems,
• 14:09
  get
• 14:09
  through
• 14:10
  the
• 14:10
  side
• 14:10
  effects
• 14:10
  and
• 14:11
  continue
• 14:11
  the
• 14:11
  medication.
• 14:12
  Right.
• 14:13
  I
• 14:13
  really
• 14:14
  loved
• 14:14
  this
• 14:14
  study.
• 14:15
  It
• 14:15
  shines
• 14:15
  a
• 14:16
  light
• 14:16
  on
• 14:16
  Lexapro
• 14:17
  that
• 14:17
  it
• 14:17
  might
• 14:18
  be
• 14:18
  a
• 14:19
  very
• 14:19
  good
• 14:19
  antidepressant
• 14:20
  of
• 14:20
  choice
• 14:21
  if
• 14:21
  you're
• 14:21
  looking
• 14:22
  for
• 14:22
  tolerability
• 14:22
  and
• 14:22
  acceptability.
• 14:23
  Remember,
• 14:23
  it
• 14:24
  has
• 14:24
  very
• 14:24
  few
• 14:24
  drug
• 14:24
  interactions,
• 14:25
  very
• 14:26
  few
• 14:26
  CYP450
• 14:27
  interactions.
• 14:28
  And
• 14:29
  as
• 14:29
  we
• 14:29
  learned
• 14:29
  from
• 14:30
  other
• 14:30
  episodes
• 14:31
  on
• 14:31
  here,
• 14:32
  the
• 14:32
  less
• 14:32
  of
• 14:32
  those
• 14:33
  interactions,
• 14:33
  the
• 14:34
  better
• 14:34
  in
• 14:34
  some
• 14:34
  ways
• 14:35
  because
• 14:36
  you're
• 14:36
  not
• 14:36
  inhibiting
• 14:37
  other
• 14:37
  drugs,
• 14:38
  which
• 14:38
  will
• 14:38
  cause
• 14:38
  more
• 14:39
  side
• 14:39
  effects.
• 14:40
  It's
• 14:40
  not
• 14:40
  making
• 14:40
  your
• 14:41
  other
• 14:41
  medications
• 14:42
  less
• 14:42
  efficacious.
• 14:43
  It's
• 14:43
  not
• 14:43
  inducing
• 14:44
  other
• 14:44
  medications
• 14:45
  and
• 14:45
  clearing
• 14:45
  them
• 14:45
  out
• 14:45
  faster
• 14:46
  metabolically.
• 14:47
  It's
• 14:47
  just
• 14:48
  kind
• 14:48
  of
• 14:48
  a
• 14:48
  lower
• 14:48
  drama
• 14:49
  medication,
• 14:50
  which
• 14:50
  is
• 14:51
  really
• 14:51
  cool.
• 14:51
  That's
• 14:52
  especially
• 14:52
  useful
• 14:52
  if
• 14:52
  you
• 14:53
  have
• 14:53
  a
• 14:53
  patient
• 14:53
  on
• 14:53
  20
• 14:53
  different
• 14:54
  medications.
• 14:54
  I
• 14:55
  don't
• 14:55
  want
• 14:55
  to
• 14:55
  go
• 14:55
  with
• 14:56
  some
• 14:56
  inhibitor
• 14:57
  like
• 14:57
  Paxil
• 14:57
  or
• 14:58
  even
• 14:58
  Prozac.
• 14:58
  That
• 14:59
  makes
• 14:59
  me
• 14:59
  nervous
• 14:59
  because
• 15:00
  there's
• 15:00
  potential
• 15:00
  drug
• 15:00
  interactions,
• 15:01
  even
• 15:01
  though
• 15:01
  those
• 15:02
  might
• 15:02
  be
• 15:02
  very
• 15:02
  fine
• 15:03
  medications
• 15:04
  for
• 15:04
  the
• 15:04
  patient
• 15:04
  in
• 15:05
  front
• 15:05
  of
• 15:05
  you.
• 15:05
  You
• 15:06
  see
• 15:06
  their
• 15:06
  med
• 15:06
  list
• 15:07
  and
• 15:07
  you're
• 15:07
  like,
• 15:07
  wait
• 15:07
  a
• 15:07
  minute,
• 15:07
  I
• 15:08
  need
• 15:08
  something
• 15:08
  with
• 15:08
  minimal
• 15:09
  CYP450
• 15:10
  interactions.
• 15:11
  And
• 15:11
  Lexapro
• 15:12
  is
• 15:12
  probably
• 15:12
  better
• 15:13
  for
• 15:13
  that.
• 15:13
  Every
• 15:14
  patient
• 15:14
  is
• 15:14
  like
• 15:15
  a
• 15:15
  snowflake.
• 15:15
  They're
• 15:15
  very
• 15:16
  unique.
• 15:16
  And
• 15:17
  there's
• 15:17
  not
• 15:18
  necessarily
• 15:18
  a
• 15:18
  perfect
• 15:19
  answer
• 15:19
  that
• 15:20
  anyone
• 15:20
  can
• 15:20
  just
• 15:21
  share
• 15:21
  with
• 15:21
  you
• 15:21
  today
• 15:22
  other
• 15:22
  than
• 15:22
  to
• 15:23
  give
• 15:23
  you
• 15:23
  things
• 15:24
  to
• 15:24
  think
• 15:24
  about.
• 15:25
  Kind
• 15:25
  of
• 15:25
  a
• 15:25
  North
• 15:26
  Star
• 15:26
  to
• 15:26
  gravitate
• 15:27
  towards.
• 15:27
  If
• 15:27
  you
• 15:28
  want
• 15:28
  simplicity,
• 15:29
  you
• 15:29
  have
• 15:29
  a
• 15:29
  patient
• 15:29
  who's
• 15:30
  medication
• 15:30
  naive,
• 15:31
  or
• 15:31
  if
• 15:31
  you
• 15:31
  have
• 15:31
  a
• 15:32
  patient
• 15:32
  who's
• 15:32
  on
• 15:32
  a
• 15:32
  lot
• 15:32
  of
• 15:32
  different
• 15:33
  medications,
• 15:33
  has
• 15:33
  a
• 15:34
  low
• 15:34
  tolerability
• 15:34
  for
• 15:35
  increased
• 15:35
  side
• 15:35
  effects
• 15:36
  or
• 15:36
  the
• 15:36
  drama
• 15:37
  of
• 15:37
  polypharmacy,
• 15:37
  then
• 15:38
  Lexapro
• 15:38
  might
• 15:38
  be
• 15:39
  your
• 15:39
  thing.
• 15:39
  That
• 15:40
  is
• 15:40
  not
• 15:40
  to
• 15:40
  say
• 15:40
  you
• 15:40
  won't
• 15:41
  experience
• 15:41
  side
• 15:41
  effects
• 15:42
  on
• 15:42
  Lexapro.
• 15:42
  You
• 15:43
  absolutely
• 15:43
  can,
• 15:43
  and
• 15:43
  I
• 15:44
  have
• 15:44
  patients
• 15:44
  who
• 15:44
  absolutely
• 15:45
  do.
• 15:45
  But
• 15:46
  again,
• 15:46
  it's
• 15:46
  about
• 15:47
  hedging
• 15:47
  risk.
• 15:48
  It's
• 15:48
  about
• 15:48
  being
• 15:48
  intentional
• 15:49
  with
• 15:49
  what
• 15:50
  you're
• 15:50
  choosing.
• 15:51
  And
• 15:52
  I
• 15:52
  think
• 15:52
  that
• 15:52
  this
• 15:52
  study
• 15:53
  really
• 15:53
  highlights
• 15:53
  a
• 15:54
  lot
• 15:54
  of
• 15:54
  virtues
• 15:55
  with
• 15:55
  respect
• 15:55
  to
• 15:55
  Lexapro
• 15:56
  and
• 15:57
  very
• 15:57
  important
• 15:57
  things
• 15:58
  we
• 15:58
  can
• 15:58
  think
• 15:58
  about
• 15:58
  and
• 15:59
  talk
• 15:59
  about
• 15:59
  if
• 15:59
  we
• 15:59
  want
• 16:00
  to
• 16:00
  prescribe
• 16:00
  it.
• 16:01
  So
• 16:01
  keep
• 16:02
  that
• 16:02
  in
• 16:02
  mind,
• 16:02
  my
• 16:02
  friends,
• 16:03
  the
• 16:03
  tolerability
• 16:04
  of
• 16:04
  your
• 16:04
  medications.
• 16:05
  Think
• 16:06
  about
• 16:06
  the
• 16:06
  banana
• 16:06
  versus
• 16:07
  the
• 16:07
  Brussels
• 16:07
  sprout,
• 16:08
  and
• 16:08
  if
• 16:09
  your
• 16:09
  patients
• 16:09
  love
• 16:09
  Brussels
• 16:10
  sprouts,
• 16:10
  go
• 16:11
  all
• 16:11
  in.
• 16:11
  No
• 16:12
  one's
• 16:12
  stopping
• 16:12
  you.
• 16:13
  It's
• 16:13
  just
• 16:13
  a
• 16:14
  cool
• 16:14
  thing
• 16:14
  to
• 16:14
  consider.
• 16:15
  I'll
• 16:15
  leave
• 16:16
  a
• 16:16
  link
• 16:17
  of
• 16:17
  this
• 16:17
  article
• 16:18
  in
• 16:18
  the
• 16:18
  show
• 16:18
  notes
• 16:19
  for
• 16:19
  you
• 16:19
  guys.
• 16:19
  I
• 16:20
  hope
• 16:20
  you
• 16:20
  enjoy
• 16:20
  it.
• 16:20
  Kind
• 16:20
  of
• 16:21
  nerd
• 16:21
  out
• 16:21
  on
• 16:21
  it.
• 16:21
  There's
• 16:21
  a
• 16:22
  little
• 16:22
  more
• 16:22
  details
• 16:22
  in
• 16:22
  it
• 16:22
  that
• 16:23
  you
• 16:23
  might
• 16:23
  find
• 16:24
  really
• 16:24
  interesting
• 16:25
  and
• 16:25
  so
• 16:26
  definitely
• 16:26
  enjoy
• 16:26
  that.
• 16:27
  And
• 16:27
  again,
• 16:27
  don't
• 16:27
  forget
• 16:28
  to
• 16:28
  march
• 16:28
  over
• 16:28
  to
• 16:29
  the
• 16:29
  show
• 16:29
  notes
• 16:29
  and
• 16:30
  become
• 16:30
  Patreon
• 16:31
  members
• 16:31
  where
• 16:31
  you
• 16:31
  get
• 16:31
  a
• 16:32
  slide
• 16:32
  decks
• 16:32
  full
• 16:33
  of
• 16:33
  this
• 16:33
  stuff.
• 16:33
  Early
• 16:34
  episode
• 16:34
  drops
• 16:35
  Bonus
• 16:35
  episode
• 16:35
  drops
• 16:36
  tips
• 16:36
  and
• 16:36
  pearls
• 16:37
  about
• 16:37
  how
• 16:38
  to
• 16:38
  pass
• 16:39
  your
• 16:39
  boards
• 16:40
  and
• 16:40
  kick
• 16:40
  some
• 16:40
  butt
• 16:41
  out
• 16:41
  there
• 16:41
  and
• 16:41
  practice.
• 16:42
  Always
• 16:42
  a
• 16:42
  pleasure.
• 16:43
  NPZ
• 16:44
  here
• 16:44
  your
• 16:44
  preceptor
• 16:45
  in
• 16:45
  your
• 16:45
  pocket.
• 16:46
  See
• 16:46
  you
• 16:46
  next
• 16:46
  time.
• 16:46
  Take
• 16:46
  care.
• 16:47
  Bye
• 16:47
  bye.