These are the final two lectures given by Dr. Cady in Salt Lake City, UT on June 1, 2012. The first lecture deals with the use of hormones in traditional psychiatry and medicine, as supported by the peer reviewed literature. The second lecture, which is in this slide deck "back to back" with the first one, is on what Dr. Cady refers to as "Pedal to the Metal Allopathic Psychiatry." That is - using medications with finesse and, when indicated, with forcefulness. Functional and integrated medicine does not mean sitting around eating fruits, nuts, and flakes, but rather using the best techniques and tools that we have available to us from all fields of medicine (including traditional, classical allopathic medicine).
2 & 3 together hormones, allopathic psychiatryLouis Cady, MD
Dr. Cady's update lecture for World Link Medical - August 17, 2012. Topics: use of hormones in functional medicine (and psychiatry) as well as "pedal to the metal" allopathic psychiatry.
This lecture on the relevance of hormonal optimization in mental health, was presented by Dr. Cady in Salt Lake City, UT at the 2012 Medical Seminar Series coordinated by World Link Medical.
Two Docs Talk - Cady & Gabhart "On the road again" - Owensboro, KYLouis Cady, MD
This document summarizes a talk given by two doctors on balancing thyroid, adrenal, and sex hormones. It discusses how these hormones can impact fatigue, depression, and other symptoms when suboptimal, and how testing and treatment can help optimize hormone levels to support health and well-being. Functional medicine testing and bioidentical hormone replacement therapies are presented as alternatives to conventional approaches.
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:Louis Cady, MD
Drs Cady and Gabhart of the Cady Wellness Institute deliver a "command performance" at the Kannise Hair Salon in Owensboro - apparently a hotbed interest site for information pertaining to thyroid dysfunction in women. (Hair stylists hear about it all the time!). This was a fun example of staff at CWI "taking it on the road" out to our communities to educate the lay public on topics of self-empowerment.
"Sexy" - part 3 of the CWI Lecture Series - June 2012f sss lectures series fo...Louis Cady, MD
The document discusses a talk given by Dr. Louis Cady on 21st century medicine, focusing on taking an integrated approach to optimizing hormone levels and overall health rather than just treating disease, with examples of evaluating and treating patients with hormone deficiencies even when conventional tests are considered "normal".
In this, the second part of the "Queen of Denial" lecture for Deaconess Women's Hospital, Dr. Cady takes up where Dr. Gabhart left off, reviewing - briefly and succinctly - the following topics: the needless "psychiatric victimization" of women, discrimination against women in terms of optimal levels of hormones (including testosterone), and the dangers of low DHEA, low cortisol, and low thyroid. The emphasis is that there are BIOLOGICAL things that are frequently wrong, and simply looking at the supposedly "psychiatric" or "depressed" symptoms is frequently barking up the wrong tree.
Feb., 2014 mens urological health cme testosterone replacement - Ihsaan Peer
- There are several formulations of testosterone available for treating deficiency including injections, patches, gels, and oral.
- Factors that influence which agent to prescribe include safety, efficacy, patient preference, and cost/insurance coverage.
- Absolute contraindications to testosterone therapy include prostate or breast cancer and hematocrit over 54%. Relative contraindications include severe lower urinary tract symptoms, prostate nodule, and cardiovascular conditions.
This document discusses testosterone replacement therapy (TRT). It covers indications for TRT including hypogonadism and symptoms of low testosterone. It describes methods of testosterone delivery including gels, patches, injections, and pellets. It discusses follow up testing and potential risks and side effects of TRT. Adjunctive therapies like HCG are also summarized.
2 & 3 together hormones, allopathic psychiatryLouis Cady, MD
Dr. Cady's update lecture for World Link Medical - August 17, 2012. Topics: use of hormones in functional medicine (and psychiatry) as well as "pedal to the metal" allopathic psychiatry.
This lecture on the relevance of hormonal optimization in mental health, was presented by Dr. Cady in Salt Lake City, UT at the 2012 Medical Seminar Series coordinated by World Link Medical.
Two Docs Talk - Cady & Gabhart "On the road again" - Owensboro, KYLouis Cady, MD
This document summarizes a talk given by two doctors on balancing thyroid, adrenal, and sex hormones. It discusses how these hormones can impact fatigue, depression, and other symptoms when suboptimal, and how testing and treatment can help optimize hormone levels to support health and well-being. Functional medicine testing and bioidentical hormone replacement therapies are presented as alternatives to conventional approaches.
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:Louis Cady, MD
Drs Cady and Gabhart of the Cady Wellness Institute deliver a "command performance" at the Kannise Hair Salon in Owensboro - apparently a hotbed interest site for information pertaining to thyroid dysfunction in women. (Hair stylists hear about it all the time!). This was a fun example of staff at CWI "taking it on the road" out to our communities to educate the lay public on topics of self-empowerment.
"Sexy" - part 3 of the CWI Lecture Series - June 2012f sss lectures series fo...Louis Cady, MD
The document discusses a talk given by Dr. Louis Cady on 21st century medicine, focusing on taking an integrated approach to optimizing hormone levels and overall health rather than just treating disease, with examples of evaluating and treating patients with hormone deficiencies even when conventional tests are considered "normal".
In this, the second part of the "Queen of Denial" lecture for Deaconess Women's Hospital, Dr. Cady takes up where Dr. Gabhart left off, reviewing - briefly and succinctly - the following topics: the needless "psychiatric victimization" of women, discrimination against women in terms of optimal levels of hormones (including testosterone), and the dangers of low DHEA, low cortisol, and low thyroid. The emphasis is that there are BIOLOGICAL things that are frequently wrong, and simply looking at the supposedly "psychiatric" or "depressed" symptoms is frequently barking up the wrong tree.
Feb., 2014 mens urological health cme testosterone replacement - Ihsaan Peer
- There are several formulations of testosterone available for treating deficiency including injections, patches, gels, and oral.
- Factors that influence which agent to prescribe include safety, efficacy, patient preference, and cost/insurance coverage.
- Absolute contraindications to testosterone therapy include prostate or breast cancer and hematocrit over 54%. Relative contraindications include severe lower urinary tract symptoms, prostate nodule, and cardiovascular conditions.
This document discusses testosterone replacement therapy (TRT). It covers indications for TRT including hypogonadism and symptoms of low testosterone. It describes methods of testosterone delivery including gels, patches, injections, and pellets. It discusses follow up testing and potential risks and side effects of TRT. Adjunctive therapies like HCG are also summarized.
1. The document discusses erectile dysfunction (ED), including its anatomy, physiology, etiology, evaluation, and treatment. It defines ED and describes the neurovascular processes underlying erection.
2. Common organic, psychogenic, and mixed causes of ED are outlined. Evaluation involves history, physical exam, and investigations.
3. Treatment options discussed include lifestyle modifications and first-line oral phosphodiesterase type 5 inhibitors like sildenafil, tadalafil, and vardenafil. Guidelines on their use and dosing are provided.
Erectile dysfunction is defined as the inability to attain or maintain an erection sufficient for sexual activity. It affects up to 52% of men aged 40-70 years. The prevalence increases with age. Psychogenic erectile dysfunction is caused predominantly by psychological or interpersonal factors. Evaluation of erectile dysfunction involves obtaining a detailed medical, psychiatric and sexual history. Physical examination and laboratory tests help identify potential organic causes. Nocturnal penile tumescence monitoring can help distinguish between organic and psychogenic erectile dysfunction.
Erectile Dysfunction Symptoms And TreatmentManas Das
This presentation describes Symptoms And Treatment of Erectile Dysfunction which is a very common diseases in men.Erectile Dysfunction can be cure easily if proper treatment will be taken.To identify Erectile Dysfunction some symptoms are there which can help you.
This document discusses erectile dysfunction caused by diabetes (DIED). It begins by explaining the physiology of erection and then discusses how diabetes damages blood vessels and nerves, impairing the mechanisms needed for erection. The prevalence of ED increases with age and poor blood sugar control in diabetes. Screening for ED is important as it can reveal other health issues. Treatments include lifestyle changes, medications like PDE5 inhibitors, injections, implants, and future options like gene therapy. Management of DIED requires assessing contributing factors, patient education, and treatment tailored to the individual.
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
This document discusses erectile dysfunction (ED), including its definition, causes, evaluation, and treatment options. It defines ED as the inability to achieve or maintain an erection firm enough for sex. Common causes include physical factors like cardiovascular disease, diabetes, and medications, as well as psychological factors like stress and depression. Evaluation involves taking a medical history, physical exam, and lab tests. Treatment options discussed include oral medications, injections, vacuum devices, penile prostheses, and referral to a urologist for more advanced cases.
Premature Ejaculation Treatment in Delhi | Clinical Management of Premature E...Vijayant Govinda Gupta
This presentation discusses clinical case scenarios for management of premature ejaculation in Delhi India.
This slides contain
1. Definition of Premature Ejacualtion
2. Management Aids
3. Clinical algorithm
4. Novel treatment modalities
Ueda2015 d erectile dysfunction patients_dr.khaled mohyueda2015
This document discusses sexual and urologic complications that can occur in patients with diabetes, including erectile dysfunction. It provides details on the pathophysiology of erectile dysfunction and normal penile erection. Evaluation and treatment options for erectile dysfunction are also summarized, including lifestyle modifications, oral medications, penile injections, implants, and surgery in some cases. Managing the underlying risks and causes of erectile dysfunction is important.
Thyroid On My Mind - IMMH, San Antonio 2014Louis Cady, MD
In this lecture, the 2nd of 4 delivered at the Integrated Medicine and Mental Health Conference in San Antonio, TX, Dr. Cady carefully reviews the literature regarding thyroid status and optimization. Multiple citations from the peer-reviewed medical literature are referenced and cited. At the conclusion of viewing this presentation, the viewer should be able to recognize the absolute fallacy of checking just TSH, and recognize the necessity of looking at the entire thyroid axis in terms of diagnosis and treatment. Relevant in depression and cognition are reviewed.
Erectile Dysfunction Treatment Without Medication or OperationBetterBlue
The most significant medical revolution in the treatment of erectile dysfunction (ED) over the past 15 years. No medication and operation. High success rate and without side effect
Erectile dysfunction (ED) is common, affecting over 150 million men worldwide. It is a marker for other neurovascular complications in diabetes. The causes of ED include vascular, neurological, endocrine, and psychological factors. Treatments include oral phosphodiesterase type 5 inhibitors, vacuum devices, intracavernosal injections, testosterone replacement, and psychosexual counseling. Managing associated conditions and hormonal deficiencies can effectively treat ED.
Erectile dysfunction is common in men with diabetes and tends to be more severe than in non-diabetic men. Screening for ED should be conducted annually as part of diabetes reviews. Asking direct questions such as "Are your erections hard enough for penetration?" can help identify cases of ED. Phosphodiesterase type 5 inhibitors are usually first-line treatment but some men may require additional options or a dose change if initial treatment is not effective. Testosterone deficiency can also contribute to ED in diabetic men.
ED is the inability to get or keep an
erection firm enough for sexual intercourse. ED can be a total inability to
achieve an erection, an inconsistent ability to do so, or a tendency to sustain
only brief erections.
ED is sometimes called impotence, but that
word is being used less often so that it will not be confused with other,
nonmedical meanings of the term.
The National Institutes of Health estimates
that ED affects as many as 30 million men in the United States. Incidence
increases with age: About 4 percent of men in their 50s and nearly 17 percent
of men in their 60s experience a total inability to achieve an erection. The
incidence jumps to 47 percent for men older than 75. But ED is not an
inevitable part of aging. ED is treatable at any age.
This document provides an overview of the evaluation and management of seizures. It discusses the prevalence and types of seizures, differential diagnosis, classification, assessment including history, physical exam, labs and imaging. Management of new onset seizures, abortive therapies like benzodiazepines, antiepileptic drugs, and refractory status epilepticus are covered. It emphasizes the importance of rapid treatment since time to treatment affects response, and simplifying the approach with a standardized status epilepticus management algorithm.
Dr. Aaron Spitz's 2006 presentation on disorders of ejaculation. Presented as part of his work as an Assistant Clinical Professor at UC Irvine's Department of Urology.
The document defines erectile dysfunction and discusses its pathophysiology, epidemiology, classification, diagnostic evaluation, and treatment options. Some key points:
- Erectile dysfunction is defined as the inability to attain/maintain an erection for satisfactory sexual performance for 3 months.
- Prevalence increases with age, ranging from 6-64% depending on age subgroups according to studies.
- Causes can be organic, relational, psychological or a mix (primary or secondary).
- Evaluation involves medical history, physical exam, questionnaires, and optional tests to identify reversible factors.
- Treatment progresses from lifestyle changes, to oral medications, injections, and finally implants if other options fail.
This document discusses the potential role of neuromodulation, specifically repetitive transcranial magnetic stimulation (rTMS), in the treatment of anorexia nervosa (AN). AN is characterized by abnormalities in brain regions involved in reward processing, decision making, and interoception. Preliminary evidence suggests rTMS targeting the dorsolateral prefrontal cortex may improve core AN symptoms, mood, and self-regulation. Several small studies and case reports provide initial support that rTMS is a safe, tolerable and may have therapeutic potential for AN, but more rigorous randomized controlled trials are still needed.
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...Mohand Yaghi
A lecture about the effect of diabetes mellitus on the erectile function. Dr. Mohand Yaghi was an invited speaker in Al-Jahra scientific day, Kuwait 2015.
Thyroid, Adrenals, & Sex Hormones: A Balancing ActLouis Cady, MD
This document summarizes key points about balancing thyroid, adrenal, and sex hormones for optimal health and mental wellness. It discusses how these hormone systems can become imbalanced, leading to fatigue, depression, and other symptoms. The document contrasts an "optimal" level of hormone functioning with merely being in the "normal" range. It also critiques conventional medical approaches and advocates an integrated approach considering all aspects of these hormone systems.
Thyroid, Adrenals, and Sex Steroids - A Balancing ActLouis Cady, MD
This was the second presentation gibven on MZarch 29, 2019 at the Manlove Psychiagtric Group and Brain Injury Institute spring conference in Rapid City, SD.
In this presentation, Dr. Cady carefully goes over the necessity of integrating and overview and awareness of hormones and their levels in the elucidation of what truly is going on with the patient.
This was an overview lecture only. Dr. Cady will be presenting a 16 hour CME program in Austin Texas on June 22 and 23 for the National Procedures Institute, and will explore all aspects of all relevant hormones and what can be done to manage and optimize them.
1. The document discusses erectile dysfunction (ED), including its anatomy, physiology, etiology, evaluation, and treatment. It defines ED and describes the neurovascular processes underlying erection.
2. Common organic, psychogenic, and mixed causes of ED are outlined. Evaluation involves history, physical exam, and investigations.
3. Treatment options discussed include lifestyle modifications and first-line oral phosphodiesterase type 5 inhibitors like sildenafil, tadalafil, and vardenafil. Guidelines on their use and dosing are provided.
Erectile dysfunction is defined as the inability to attain or maintain an erection sufficient for sexual activity. It affects up to 52% of men aged 40-70 years. The prevalence increases with age. Psychogenic erectile dysfunction is caused predominantly by psychological or interpersonal factors. Evaluation of erectile dysfunction involves obtaining a detailed medical, psychiatric and sexual history. Physical examination and laboratory tests help identify potential organic causes. Nocturnal penile tumescence monitoring can help distinguish between organic and psychogenic erectile dysfunction.
Erectile Dysfunction Symptoms And TreatmentManas Das
This presentation describes Symptoms And Treatment of Erectile Dysfunction which is a very common diseases in men.Erectile Dysfunction can be cure easily if proper treatment will be taken.To identify Erectile Dysfunction some symptoms are there which can help you.
This document discusses erectile dysfunction caused by diabetes (DIED). It begins by explaining the physiology of erection and then discusses how diabetes damages blood vessels and nerves, impairing the mechanisms needed for erection. The prevalence of ED increases with age and poor blood sugar control in diabetes. Screening for ED is important as it can reveal other health issues. Treatments include lifestyle changes, medications like PDE5 inhibitors, injections, implants, and future options like gene therapy. Management of DIED requires assessing contributing factors, patient education, and treatment tailored to the individual.
Invited lecture delivered by Dr Sujoy Dasgupta in a Webinar organized by Sexual medicine Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in February, 2022
This document discusses erectile dysfunction (ED), including its definition, causes, evaluation, and treatment options. It defines ED as the inability to achieve or maintain an erection firm enough for sex. Common causes include physical factors like cardiovascular disease, diabetes, and medications, as well as psychological factors like stress and depression. Evaluation involves taking a medical history, physical exam, and lab tests. Treatment options discussed include oral medications, injections, vacuum devices, penile prostheses, and referral to a urologist for more advanced cases.
Premature Ejaculation Treatment in Delhi | Clinical Management of Premature E...Vijayant Govinda Gupta
This presentation discusses clinical case scenarios for management of premature ejaculation in Delhi India.
This slides contain
1. Definition of Premature Ejacualtion
2. Management Aids
3. Clinical algorithm
4. Novel treatment modalities
Ueda2015 d erectile dysfunction patients_dr.khaled mohyueda2015
This document discusses sexual and urologic complications that can occur in patients with diabetes, including erectile dysfunction. It provides details on the pathophysiology of erectile dysfunction and normal penile erection. Evaluation and treatment options for erectile dysfunction are also summarized, including lifestyle modifications, oral medications, penile injections, implants, and surgery in some cases. Managing the underlying risks and causes of erectile dysfunction is important.
Thyroid On My Mind - IMMH, San Antonio 2014Louis Cady, MD
In this lecture, the 2nd of 4 delivered at the Integrated Medicine and Mental Health Conference in San Antonio, TX, Dr. Cady carefully reviews the literature regarding thyroid status and optimization. Multiple citations from the peer-reviewed medical literature are referenced and cited. At the conclusion of viewing this presentation, the viewer should be able to recognize the absolute fallacy of checking just TSH, and recognize the necessity of looking at the entire thyroid axis in terms of diagnosis and treatment. Relevant in depression and cognition are reviewed.
Erectile Dysfunction Treatment Without Medication or OperationBetterBlue
The most significant medical revolution in the treatment of erectile dysfunction (ED) over the past 15 years. No medication and operation. High success rate and without side effect
Erectile dysfunction (ED) is common, affecting over 150 million men worldwide. It is a marker for other neurovascular complications in diabetes. The causes of ED include vascular, neurological, endocrine, and psychological factors. Treatments include oral phosphodiesterase type 5 inhibitors, vacuum devices, intracavernosal injections, testosterone replacement, and psychosexual counseling. Managing associated conditions and hormonal deficiencies can effectively treat ED.
Erectile dysfunction is common in men with diabetes and tends to be more severe than in non-diabetic men. Screening for ED should be conducted annually as part of diabetes reviews. Asking direct questions such as "Are your erections hard enough for penetration?" can help identify cases of ED. Phosphodiesterase type 5 inhibitors are usually first-line treatment but some men may require additional options or a dose change if initial treatment is not effective. Testosterone deficiency can also contribute to ED in diabetic men.
ED is the inability to get or keep an
erection firm enough for sexual intercourse. ED can be a total inability to
achieve an erection, an inconsistent ability to do so, or a tendency to sustain
only brief erections.
ED is sometimes called impotence, but that
word is being used less often so that it will not be confused with other,
nonmedical meanings of the term.
The National Institutes of Health estimates
that ED affects as many as 30 million men in the United States. Incidence
increases with age: About 4 percent of men in their 50s and nearly 17 percent
of men in their 60s experience a total inability to achieve an erection. The
incidence jumps to 47 percent for men older than 75. But ED is not an
inevitable part of aging. ED is treatable at any age.
This document provides an overview of the evaluation and management of seizures. It discusses the prevalence and types of seizures, differential diagnosis, classification, assessment including history, physical exam, labs and imaging. Management of new onset seizures, abortive therapies like benzodiazepines, antiepileptic drugs, and refractory status epilepticus are covered. It emphasizes the importance of rapid treatment since time to treatment affects response, and simplifying the approach with a standardized status epilepticus management algorithm.
Dr. Aaron Spitz's 2006 presentation on disorders of ejaculation. Presented as part of his work as an Assistant Clinical Professor at UC Irvine's Department of Urology.
The document defines erectile dysfunction and discusses its pathophysiology, epidemiology, classification, diagnostic evaluation, and treatment options. Some key points:
- Erectile dysfunction is defined as the inability to attain/maintain an erection for satisfactory sexual performance for 3 months.
- Prevalence increases with age, ranging from 6-64% depending on age subgroups according to studies.
- Causes can be organic, relational, psychological or a mix (primary or secondary).
- Evaluation involves medical history, physical exam, questionnaires, and optional tests to identify reversible factors.
- Treatment progresses from lifestyle changes, to oral medications, injections, and finally implants if other options fail.
This document discusses the potential role of neuromodulation, specifically repetitive transcranial magnetic stimulation (rTMS), in the treatment of anorexia nervosa (AN). AN is characterized by abnormalities in brain regions involved in reward processing, decision making, and interoception. Preliminary evidence suggests rTMS targeting the dorsolateral prefrontal cortex may improve core AN symptoms, mood, and self-regulation. Several small studies and case reports provide initial support that rTMS is a safe, tolerable and may have therapeutic potential for AN, but more rigorous randomized controlled trials are still needed.
Diabetes mellitus and erectile dysfunction by Dr. Mohand Yaghi PgDip (urol) C...Mohand Yaghi
A lecture about the effect of diabetes mellitus on the erectile function. Dr. Mohand Yaghi was an invited speaker in Al-Jahra scientific day, Kuwait 2015.
Thyroid, Adrenals, & Sex Hormones: A Balancing ActLouis Cady, MD
This document summarizes key points about balancing thyroid, adrenal, and sex hormones for optimal health and mental wellness. It discusses how these hormone systems can become imbalanced, leading to fatigue, depression, and other symptoms. The document contrasts an "optimal" level of hormone functioning with merely being in the "normal" range. It also critiques conventional medical approaches and advocates an integrated approach considering all aspects of these hormone systems.
Thyroid, Adrenals, and Sex Steroids - A Balancing ActLouis Cady, MD
This was the second presentation gibven on MZarch 29, 2019 at the Manlove Psychiagtric Group and Brain Injury Institute spring conference in Rapid City, SD.
In this presentation, Dr. Cady carefully goes over the necessity of integrating and overview and awareness of hormones and their levels in the elucidation of what truly is going on with the patient.
This was an overview lecture only. Dr. Cady will be presenting a 16 hour CME program in Austin Texas on June 22 and 23 for the National Procedures Institute, and will explore all aspects of all relevant hormones and what can be done to manage and optimize them.
The document discusses an integrative medicine presentation on hypothyroidism and the thyroid. It provides background on the speaker's commercial relationships and credentials. The presentation examines the limitations of conventional thyroid testing and treatment, exploring additional factors like selenium, iron, and cortisol that can impact thyroid function at the tissue level. It advocates for a more comprehensive evaluation and management of hypothyroidism that considers multiple nutritional and lifestyle factors.
This is the second of five lectures given by Dr. Cady in Santa Fe, NM for the 2012 IMMH conference. It covers the need to identify the hormonal deficiencies of a patient, and ways to remediate them.
Hormones and Mental Health - Thyroid and Testosterone.pptxLouis Cady, MD
In this presentation for the Psychiatry Redefined program, Dr.
Cady breaks down and deconstructs the accepted, unthinking, "practice guideline based" notions of thyroid and tesotsterone, with there seemingly "normal" levels and dosing, versus what the actual peer reviewed medical literature says. In this presentation, do use of all forms of thyroid, and all forms of testosterone are reviewed. The idiocy of "T4 only treatment" is covered. The use of T4, T3, a combination of T4 and T3, and all of the porcine and compounded products is review.
In terms of testosterone, dr. Katie reviews the concept of "do you want to be optimal or do you want to be normal." He notes that it is "normal" for oil in cars to deteriorate and break down with age. It's also "normal" for men's and women's testosterone (as well as thyroid) to go down with age. The question is, "do we want to do anything about it?"
Logical ways of intervening in both the thyroid and female and male gonadal axes are covered. There is scrupulous attention paid to the thyroid hormone pathways, and the relevance of reverse T3 versus free T3. Similarly, in terms of women, the downstream effect of estradiol coming from testosterone is also reviewed.
I would take good care of a classic car by following the maintenance schedule in the owner's manual. This would include regularly changing the oil, transmission fluid, brake fluid, and other fluids to keep them fresh. I'd also inspect hoses, belts, and other components periodically to catch any issues early. With preventative maintenance and repairs as needed, a classic car can remain in good working condition and be enjoyed for many years. Neglecting routine fluid changes and repairs is not advising for optimal performance or longevity.
Dr. Cady returned to IMMH in Orange County to deliver this talk on September 28, 2017. This is his fifth presentation on this topic to the Integrated Medicine and Mental Health conference.
In this presentation, Dr. Cady reviews common misconceptions about the evaluation of the thyroid axis, dosing concerns, actual studies on patients and real-world clinical data. A large appendix and reference is included at this end of this presentation for things which were not able to be covered in the time allotted. These include the role of thyroid hormone on cognition, the role of thyroid hormone in head injury, and an exploration of the role of thyroid hormone in possibly preventing, and possibly actually treating Alzheimer's disease (as one of MANY targeted pharmaceutical, nutraceutical and integrative modalities.)
The Integrative Treatment of Depression, Schizophrenia & Autism - IMMH 2015Louis Cady, MD
This is the first of three lectures given by Dr. Cady at the 6th annual Integrative Medicine and Mental Health Conference in San Diego, on September 18, 2015. In it, Dr. Cady deconstructs the contributing factors to either exacerbating or causing a diagnosable mental disorder. The use of understanding the pathophysiology of the entire body, and not just firing antidepressants and other psychotropic drugs blindly into the patient without thinking, is clearly reviewed.
This document provides an overview of a lecture on thyroid health. It begins with the speaker, Louis Cady, MD, disclosing commercial relationships and interests. It then outlines the structure of the lecture, which will cover thyroid basics, practical information, and conclusions. The document discusses conventional thyroid testing and its limitations. It also reviews factors that affect thyroid hormone production and conversion. Overall, the document introduces topics to be covered in the lecture regarding thyroid function and testing.
This document discusses hormone replacement therapy using bioidentical hormones. It notes that hormones play an important role in health for both men and women, and that hormone imbalance can cause many symptoms. Pellet therapy is presented as the most effective delivery method for bioidentical hormones, providing steady levels without side effects. The benefits of hormone balancing for conditions like menopause, andropause, osteoporosis, Alzheimer's, heart health, and arthritis are summarized. Key takeaways emphasize finding an expert for individualized hormone testing and therapy.
Scratching Your Head Psychiatry: Practicing OUTSIDE of the Allopathic BoxLouis Cady, MD
In this first lecture of his 5-lecture series for IMMH in Santa Fe, NM, Dr. Cady reviews the absolute need to get the biological basis right in confusing and confounding cases. Using real patient stories, he illustrates the blending of functional testing, food allergy testing, and hormonal interventions.
Perinatal hormones, mood, and cognition - 2007Hormones Matter
1) The document discusses hormones and their relationship to mood disorders in women, specifically during reproductive stages like puberty, pregnancy, postpartum, and menopause.
2) It presents research showing elevated levels of the adrenal androgen DHEAS are associated with psychiatric symptoms in the postpartum period, while lower levels of pregnancy testosterone may be an early warning sign.
3) The research found that as hormone levels like DHEAS and progesterone normalized in the year following childbirth, psychiatric symptoms tended to abate, though chronically elevated DHEAS was linked to ongoing issues.
This document summarizes information about androgen deficiency in aging men (ADAM syndrome). It discusses the physiology of androgens and how levels change with aging. ADAM syndrome, also called late-onset hypogonadism, describes the effects of declining testosterone in older men. Testosterone replacement therapy can improve sexual function, bone density, lean muscle mass, mood and cognition. However, risks include prostate issues and erythrocytosis. Guidelines recommend monitoring prostate-specific antigen and hematocrit for men undergoing testosterone replacement. More research is still needed to fully understand the risks and benefits of testosterone therapy in older men.
The document provides a summary of a patient case involving a 22-year-old female admitted for increasing depression symptoms. She has a history of eating disorder, depression, anxiety, and insomnia. On examination, she has a low BMI and recent weight loss. Laboratory tests show normal results. The patient is taking several psychotropic medications and has been followed by an eating disorder dietitian. The document discusses recommendations for her diet and omega-3 supplementation to support her mental health conditions.
Bioidentical Hormone Replacement presentation version 2Paul Cox
This document discusses hormone optimization for men through regenerative and integrative medicine approaches. It provides background on the author's qualifications and outlines key concepts in functional and anti-aging medicine like optimizing the body's self-repair mechanisms with hormones, lifestyle changes, and supplements. Specific hormone pathways like thyroid and testosterone are examined, symptoms of deficiencies are defined, and testing and treatment options like bioidentical hormones, gels, injections, and implants are described. The benefits of hormone optimization are stated to include increased energy, mood, mental clarity, fitness and sex drive. Brief patient testimonials endorse the positive effects.
This document provides an overview of the thyroid gland and its relevance in psychiatry. It discusses the anatomy and physiology of the thyroid, common thyroid disorders like hypothyroidism and hyperthyroidism, thyroid function tests, and the role of thyroid abnormalities in various psychiatric conditions like depression, psychosis, cognitive dysfunction, anxiety, and mental retardation. It also covers thyroid dysfunction that can be induced by psychotropic medications like lithium and discusses treatment guidelines for thyroid replacement.
This document discusses the complex neurochemistry underlying exercise and human behavior. It notes that every individual's brain chemistry and response to exercise is unique due to genetic and environmental factors. While certain neurotransmitters like dopamine and endorphins generally promote exercise motivation and pain suppression, their levels and effects vary significantly between individuals. The document advocates that trainers and coaches recognize this bioindividuality and psychoindividuality to develop more effective, personalized training programs. It also stresses that more research is still needed to fully understand how exercise impacts the brain.
This is the first of four CME lectures delivered by Dr. Cady at the 4rth Annual Integrated Medicine For Mental Health Conference in Chicago, IL at McCormick Place, September 21, 2013. In it, he deconstructs the facts and fallacies surrounding the thyroid axis, what should be measured, why it's important, and what happens to patients with suboptimal thyroid status.
The scientific literature, quoted right up to the day before the conference started, is extensive and well sourced.
Any practicing physician, and certainly any interested patient(s) should familiarize himself or herself with this content.
This document discusses connections between movement, mood, and memory. It explores mood disorders like depression and Alzheimer's disease, and how exercise can positively impact both. Regular exercise is suggested to reduce risks of many chronic diseases, as well as depression and Alzheimer's. The benefits of exercise are explained from psychological, neurogenic, and neurochemical perspectives. Goals and strategies for starting an exercise routine are also outlined.
Similar to Homones & allopathic psychiatry (together) (20)
SEND IN THE SHRINKS - 2009 Oliver CME seminarLouis Cady, MD
This one was fun.
I was invited by Dr. Randalll Oliver, MD, Founder of the Oliver Heachache and Pain Clinic in Evansville, to present to an audience of primary care practitioners about how to use pysychiatric mediations ("psychopharmacology") in clinical practice.
Along the way, I covered, ADHD and treatments, depression, anxiety, erectile dysfunction, hypoadrenia, and even touched on hypothyroidism. Although this presentation was in 2009, all of the drugs covered are stills in use, and, at times.... stupidly.
This presentation deconstructs the intricacies of selecting and antidepressant, particularly in the SSRI class.
What is the nature of QUALITY in medicine -for ASQ 11 14 2023.pptLouis Cady, MD
In this presentation, Dr. Cady deconstructs the tensions and stressors on both patients and health care providers in today's system.
This presentation reviews checklists foe liminating mistakes, the actual number of mistakes that are being made in medical practice, and what patients and their loved ones can do for self protection.
This isn't a "bash the doctor" presentation. It's a thoughtful, careful exploration of stresses and ramifications to the current US healthcare system.
This document provides information about a presentation given by Dr. Louis B. Cady on transcranial magnetic stimulation (TMS) as a treatment for depression. It begins with Dr. Cady's credentials and commercial disclosure stating he has received honoraria from several companies but that this presentation is not being underwritten by any company. The presentation then covers how TMS works, its safety and effectiveness compared to antidepressant medications and electroconvulsive therapy (ECT), and its inclusion in treatment guidelines for depression.
The Moral Imperative of Integrative Medicine 2022.pptLouis Cady, MD
The document discusses the case of a 16-year-old teenager with a long history of treatment-resistant depression and anxiety. Previous medication trials with SSRIs, SNRIs, atypical antipsychotics, and lamotrigine had failed to provide sustained relief. Upon further evaluation, the doctor found potential contributing factors including an undiagnosed MTHFR gene mutation and hormonal imbalances. The doctor adjusted the teenager's supplements and medications, focusing on addressing the underlying functional issues. At follow-up several months later, the teenager reported significantly improved mood with only brief periods of low mood, though menstrual irregularities persisted.
CORONOFOBIA - Passos práticos para equilibrar as defesas do corpo e da menteLouis Cady, MD
Esta palestra, apresentada em 29 de maio de 2021 para o Congresso de Medicina Integrativa para a Saúde Mental 2020, promovido pelo Laboratório Great Plains no Brasil, enfocou coisas simples e de bom senso que os pacientes (e seus médicos) podem fazer para se manter seguros e viver durante o Pandemia do covid.
Os seguintes conceitos holísticos foram revisados:
- sono adequado e por que é tão importante;
- o uso de melatonina, cientificamente validada como tendo atividade antiviral (referências citadas);
- a importância de diminuir o estresse e técnicas para fazê-lo;
- a necessidade de "comer frutas e vegetais" como sua mãe e sua avó ensinaram devido à ingestão de carotenóides e antioxidantes ((referências citadas);
- o uso adequado de suplementos vitamínicos / nutricionais (referências citadas).
O foco desta apresentação não foram medidas heróicas para salvar vidas na unidade de terapia intensiva para pacientes gravemente enfermos com COVID, mas, sim, técnicas de bom senso, práticas, baratas e (em alguns casos) GRATUITAS para melhorar você e seus pacientes 'saúde e resistência às doenças.
THE MORAL IMPERATIVE OF INTEGRATIVE MEDICINE - O IMPERATIVO MORAL DA MEDICINA...Louis Cady, MD
Neste programa, o Dr. Cady baseia-se em uma série de casos clínicos para ilustrar a necessidade absoluta e moral do tratamento de precisão de nossos pacientes com todas as ferramentas disponíveis para uso por meio da medicina integrativa.
O uso de testes de polimorfismo MTHFR, testes convencionais e laboratoriais e testes farmacogenômicos foram revisados.
Os casos apresentados ilustram a trágica dificuldade de um menino com deficiência de MTHFR que estava prestes a desviar sua vida; um paciente esquizofrênico com vários problemas de medicina funcional que precisavam ser resolvidos (levedura, glúten, sensibilidade alimentar de IgG); uma estudante universitária a quem foi dito "não há nada de errado com você; seus laboratórios estão bem", embora ela tenha manifestado todos os sintomas relevantes de hipotireoidismo; e um CEO do sexo masculino de 42 anos que estava "tão cansado que parecia morrer" e que, na verdade, estava funcionalmente com pouco testosterona. O último caso revisado foi de um adorável garotinho que tinha autismo e foi recuperado por meio de uma abordagem focada e intensa de medicina integrativa.
Dr. Cady deconstructs some the medical literature about the use of nutrients - and the evidence of what happens in the presence of their insufficiency. Everything for decreased viral replication to decrease brain shrinkage is covered. The role of antioxidant and carotenoids, measured by the Pharmanex Biophotonic Scanner, is reviewed.
Please note - there is no representation that any nutrient or supplement can treat, prevent, mitigate, or cure any medical condition. It does seem, however, upon reflecting on the medical literature, that there seems to be a lot of evidence for therapeutic effect in the presence of good levels of nutrient, and harm to patients if they have insufficient levels.
Subtitle: The Moral Imperative of Integrative Medicine
This presentation, two hours in length, was delivered to the A4m MMI Audience in their Frontiers of Neurology - Module 3.
The following topics are reviewed:
- ADHD, Autism, Depression, Schizophrenia
- the impact of neuroinflammation on all of these.
- confounding factors and the ways to mitigate them: Omega6/Omega 3 imbalance in the Western diet, MTHFR polymorphism, the use of elemental lithium, the presence of intestinal dysbiosis and the role of gluten/dairy IgG Food allergies.
- pharmacogenomic testing
The Moral Imperative of Integrative Medicine - IMMH 2020Louis Cady, MD
IN this presentation, Dr. Cady reviews several of the handful of functional, integrative medicine techniques required for a holistic and comprehensive management of psychiatric issues. MTHFR, hormone balance, diagnosis and treating intestinal dysbiosis, need for trace elements, and hormones (including thyroid, testosterone and estradiol) are reviewed.
This brief webinar, a gift to the local Jewish community and Temple Adath B'Nai Israel here in Evansville, IN, reviews the tradition of mindfulness and the interdigitation of Buddhist practices with some Jewish traditions. Dr. Cady reviews the downstream effects of stress, how meditation and mindfulness are useful tools and techniques, and actually how to practice it. Multiple references without being complicated or overdone are provided.
Webinar 5: Designing Your Future: WHAT'S COMING NEXT?Louis Cady, MD
In this capstone webinar presentation, closing out Dr. Cady's series on dealing with COVID 19, he turns his attention to a nunmber of interesting thems:
- what's the REAL case fatality rate of COVID 19
- How is it likely that society will reopen?
- What's going to happen in education and medicine?
- What's going to happen when the robots and AI arrive?
- What's the future going to be out 500 years?
HOW TO SAVE MONEY ON YOUR HEALTHCARE: An Integrative Medicine ApproachLouis Cady, MD
In this webinar, the fourth in a series of five from Dr. Louis Cady and the Cady Wellness Institute, we focus on the actual dollars and cents of health care expenditures, and the societal and PERSONAL costs of poor health maintenance behavior. We examine the essentially passive US medical system, that would rather drug a symptom than fix the underlying problem.
Great attention is paid on not shaming the patient or the doctors as they exist in the current system. Both groups "do not know what they do not know." Confirmation bias is rampant.
This webinar points the way to living a more vital, energetic life, with a minimum of cost, grief, and misery.
The Do It To Yourself Treatment of Depression - Webinar #3Louis Cady, MD
This is the third in a series of five webinars. The first was on staying alive by boosting your immunity during COVID 19. The second was on not screwing yourself up inside your head. This third one encompasses a romp through the peer reviewed medical literature looking for supplements and nutrients that you could use to self treat depression at home, CAREFULLY. Numerous cautions and warnings are included.
The driving impetus to this program is that many people - due to social isolation and their mental health care, or medical practitioners' offices being closed down - have not been able to get help or succeed in optimizing their treatment for depression. There are multiple useful nutrients for both depression and anxiety in nature's abundant pharmacopeia, and this webinar touches on just a few of them.
I hope you enjoy it.
HOW TO COPE WITH THE PSYCHOLOGICAL IMPACT OF COVID 19 AND SOCIAL DISTANCINGis...Louis Cady, MD
In this presentation, Dr. Cady will review:
- What did Sparky learn about not being an emotional support animal?
- "Do it to yourself psychotherapy." Learn the following:
- What are the wrong - and the RIGHT ways of any sort of "behavioral therapy"?
- How to use a journal to think RATIONALLY and “get out of your head.”
- How to get out of your HEAD and into your LIFE.
- We'll cover all 10 of David Burns’ cognitive distortions, customized and gift-wrapped for dealing with COVID 19.
- We will cover actionable examples of how to reprogram yourself.
We will review What are the 3 P's of Positive Psychology and Learned Optimism?
The Cady 5 "5P’s” and “How to shrink yourself."
Can we find the GOOD in COVID?
This presentation is meant to be provocative and to challenge you mentally, intellectually, and emotionally. Some of the great thinkers and exemplars of human performance and possibility are featured.
BOOSTING YOUR IMMUNITY During the COVID 19 PandemicLouis Cady, MD
In this presentation, presented as a live webinar on Monday, April 27th, Dr. Louis Cady of the Cady Wellness Institute reviewed practical, common-sense things that can be done to boost your immunity, with documentation from the peer-reviewed medical literature. Dr. Cady also reviews supplements and nutrients that are established in the peer-reviewed medical literature as having antiviral capabilities. These include Vitamins C,D, and E, Zinc, carotenoids and antioxidants, probiotics, the reishi mushroom, elderberry, cannabidiol (CBD - not marijuana or weed!).
Points presented are scrupulously documented from the medical literature. This presentation does not guarantee or represent that using ANY of these nutrients will "keep you from getting infected or dying" from COVID 19. They are presented for your thoughtful consideration.
Tratamento holistica de ezschizophrenia - São Paulo, Brazil April 20, 2019Louis Cady, MD
Esta é a versão em inglês da apresentação do Dr. Cady feita na UNIP (Campus Paraiso - São Paulo, SP Brasil) para o Congresso de Saúde Mental de 2019 (Conferência sobre Saúde Mental). Foi entregue em 20 de abril de 2019.
Nesta apresentação, o Dr. Cady analisa brevemente a história da esquizofrenia, a falha do bloqueio do receptor de dopamina D2 como uma cura universal na esquizofrenia, e várias intervenções holísticas que podem impactar forte e positivamente os sintomas da esquizofrenia. Incluídos na pesquisa do Dr. Cady estavam o papel dos ácidos graxos essenciais, deficiências nutricionais (particularmente vitaminas do complexo B), o perigo de supercrescimento da cândida, testes farmacogenômicos, polimorfismos da MTHFR e muito mais.
Foi uma honra e um privilégio entregar esta apresentação em
São Paulo.
Para mais informações no Brasil sobre este tema, ou para solicitar uma gravação em vídeo / áudio da conferência, entre em contato com Luiz Dias do Laboratório Grandes Planícies no Brasil.
Slides, até o apêndice, são traduzidos por Luiz Dias.
The integrative treatment of schizophrenia brazil 2019Louis Cady, MD
This is the English language version of Dr. Cady's presentation given at UNIP (Campus Paraiso - Sao Paulo, SP Brazil) for the 2019 Congresso de Saude Mental (Conference on Mental Health). It was delivered April 20, 2019.
This presentation also includes extra slides in the appendix that were not presented, and, unfortunately, these slides of the appendix have not been translated in the Portuguse version of this presentation.
In this presentation (Portuguese presentation will also be posted next), Dr. Cady briefly reviews the history of schizophrenia, the failure of the dopamine D2 receptor blockage as a universal cure-all in schizophrenia, and various holistic interventions which can strongly and positively impact symptoms of schizophrenia. Included in Dr. Cady's survey were the role of essential fatty acids, nutrient deficiencies (particularly B vitamins), the danger of overgrowth of candida , pharmacogenomic testing, MTHFR polymorphisms, and more.
It was an honor and a privilege to deliver this presentation in
São Paulo,.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
Natural Treatments for ADHD (TADH) in Sao Paulo, Brazil, for Laboratorio Grea...Louis Cady, MD
In this presentation, given at UNIP (Campus Paraiso - Sao Paulo, SP Brazo) for the 2019 Congresso de Saude Mental (Conference on Mental Health), Dr. Cady reviewed the prevalence, inheritability, and social ramifications of ADHD (TADH in Brazil). He specifically reviewed multiple holistic interventions, including limiting "electric screen time,"good quality diet with adequate amounts of essential fatty acids and critically important trace elements, and the use of pharmacogenomic testing as well as functional, integrative medicine testing, all to better characterize logical and reeasonmable points for holistic intervention.
This presentation was simultaneously translated into Portugue for the attendees, but unfortunately the slides were not available in translated form.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
This lecture was presented on March 29, 2019 in Rapid Citry, South Dakota, for the conference co-sponsored by the Manlove Psychiatric Group and the Brain Injury Center.
It reviews the uptick in diagnosis of ADHD, the raiontale for its concern, causative factors, and how it can be worked up holistically and in a balanced, not necessarily medication-oriented way.
Use of high dose fish oil, iron supplementation, and how to overrcome nutritional deficiencies are discussed.
Medical Discussion of the Endocannabinoid SystemLouis Cady, MD
This document contains a slide deck presentation on hemp oil and the endocannabinoid system. It discusses the history of research on cannabis, the endogenous cannabinoid system, and how various interventions can upregulate this system. Throughout, it stresses that the information is for educational purposes only and that no claims are being made about Zilis products treating, preventing, or curing any diseases.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
2. VISION: “We dramatically
transform the lives of our
patients and clients to levels of
peak physical and mental health,
supporting a lifetime of
maximum performance and
happiness.”
4. Critical area of concern for men &
women. Things that will make them:
• Tired &/or depressed
• Unable to cope
• “Mean”
• Stressed
• Deficient in libido or in the bedroom
• Demented
5. A Shrink meets the “anti-aging” crowd
• Patient “complaints” • Personal experience
• Loss of energy • Previous state:
• Loss of stamina “energy to burn”
• Loss of libido • “Snooze bar
• Weight gain syndrome”
• Loss of zest for life • “Piles syndrome”
• Loss of interest in career • “Why can’t I make
myself exercise?”
• “I’ve felt like I’ve been
aging since I was 35.” • Car wash MSE!
10. Useful Target Symptoms in MDD
♦ Depressed mood 100%
♦ Reduced energy: 97%3
♦ Fatigue or loss of energy: 94%2
♦ Impaired concentration: 84%3
♦ Tiredness: 73%1
♦ Hypersomnia: 10%–16%4 (Insomnia)
1. Tylee et al. Int Clin Psychopharmacol 1999;14:139-151. 2. Maurice-Tison et al. Br J Gen
Pract 1998;48:1245-1246. 3. Baker et al. Comp Psychiatry 1971;12:354-65. 4. Horwath et
al. J Affect Disord 1992;26:117-25. 5. Reynolds and Kupfer. Sleep 1987;10:199-215.
11. “But the doctor told me my thyroid
was fine.”
• Can be “wnl” but suboptimal.
• TSH frequently only thing checked.
• Nothing known about Free T4 or Free T3.
• Free T4 can be converted to Reverse T3 under
stress (cortisol)
• Free T4 can be underconverted to T3.
• Can have normal levels (or slightly elevated
levels) of everything and have auto-immune
thyroid disease.
13. “Thyrotropin (Thyroid-Stimulating
Hormone or TSH). Measuring TSH is the
most sensitive indicator of
hypothyroidism.” (hunh?!)
http://www.umm.edu/patiented/articles/how_serious_hypothyroidism
Accessed: 9/5/2011
14. Se
CORTISOL
“the foot soldier” “the evil twin”
15. Yes, T-3 DOES get into the brain
(Transthyretin = carrier protein)
Or: The idiocy of T4 only thyroid treatment…
• Terasaki, T. and Pardridge, W.M.: Stereospecificity of triiodothyronine
transport into brain, liver, and salivary gland: role of carrier- and
plasma protein-mediated transport. Endocrinology, 121(3):1185-1191,
1987.
• http://www.kingpharm.com/uploads/pdf_inserts/Cytomel_PI.pdf.
• Mooradian, A.D.: Blood-brain transport of triiodothyronine is reduced in
aged rats. Mech. Ageing Dev., 52(2-3):141-147, 1990.
• Cheng, L.Y., Outterbridge, L.V., Covatta, N.D., et al.: Film
autoradiography identifies unique features of [125I]3,3'5'-(reverse)
triiodothyronine transport from blood to brain. J. Neurophysiol.,
72(1):380-391, 1994.
• Rudas, P. and Bartha, T.: Thyroxine and triiodothyronine uptake by the
brain of chickens. Acta Vet. Hung, 41(3-4):395-408, 1993.
16. Transthyretin (a systemic amyloid precursor)
may be protective for Alzheimer’s (Why?)
Li X et al. J Neurosci 2011 Aug 31;31(55):12483-90
17. LEVEL III RESULTS:
Per HDRS – 17, remission in:
15.9% on Li
24.7% on T3
Per QIDS-SR16, remission in:
13.2% on Li
24.7% for T3 *
* Fava & Covino: Augmentation/Combination Therapy in STAR*D Trial,
Medscape Psychiatry
18.
19.
20. • Early 20’s college student
• Weight gain, fatigue, brain fog
• Saw “numerous” MD’s asking for help
• Told “nothing is wrong with your thyroid;
your labs are fine.”
22. “Hypoadrenia”: The Adrenal Problem that most
conventionally trained physicians don’t know about.
• Non-Addison’s hypoadrenia
• Subclinical hypoadrenia
• Neurasthenia
• Adrenal neurasthenia
• Adrenal apathy
• Adrenal fatigue
• “Adrenal burnout”
• “Chronic fatigue syndrome”?!!
23. The state of adrenal exhaustion can
be determined
Early-stage Chronic Mid-stage Chronic End-stage (exhausted)
Stress Response Stress Response Chronic Stress
Response
24. DHEA – the critical hormone most
doctors never check
• Produced in the adrenal cortex
– Humans and primates are unique in secreting large
amounts
• Immune system booster
• Insulin regulator
• Energy increase – remarkable
• Boosts growth hormone
– 20% in men; 30% in women in one study
• [Yen, Morales Khorram – one year double-blind placebo
controlled crossover experiment – with 100mg DHEA]
• Antidepressant
25. DHEA with Fatigue = 107
citations
6/1/2012
347 citations on “DHEA with energy” – as of
06 01 2012
26. Why isn’t adrenal fatigue diagnosed?
• Not severe enough to be an
emergency
• Symptoms can be attributed to other
things, including “just neurotic” or
“avoidant”
• “Functional medicine” testing not
typically done (& rarely is DHEA-S
checked)
• Modern medicine focuses on the
treatment of sickness, not “less than
optimal” function.
• “Bell Curve” paradigm
27. Neurobiological & neuropsychiatric effects
of DHEA & DHEAS [Maninger N et al. Front
Neuroendocrinology 2009]
• DHEA & DHEAS synthesized in adrenals
AND BRAIN.
• Biological actions of DHEA/DHEA-S:
– Neuroprotection
– Neurite growth
– Antagonistic effects on oxidants & glucocorticoids
• “accumulating data suggest abnormal DHEA
(S) concentrations in several neuropsychiatric
conditions.”
29. The Glamorous Grandmother
• 4/8/11 – 80 yo returned to practice. No real
complaints. History of depression. On Pristiq.
– Daughter “handling her finances”
• 5/2/11 – “doing terrible.”
– TSH 3.84, Free T3 2.8 – on 50 MICROgrams T4
– Fasting BS 120; HgBA1C 6.5%
– Fasting insulin 36 (!!!) {3 – 25}
– Progesterone – 0.2 {0.2 – 1.4 follicular}
– Total testosterone 11
– DHEA-S = 25 MICROgrams/dL (!!)
• Age adjusted {10 – 90} . Cenegenics = {c. 500}
• Rouzier = {300 –females, 600 males}
30. G.G. - interventions 5/2/11 & Follow-up
• Interventions:
– DHEA – 25 mg SR q a.m.
– Progesterone 200 mg/cc, Topiclick – ¼ cc at
HS, then increase to ½ cc
– Testosterone – 8mg/cc Topiclick – 1/4cc
topically for one week, then ½ cc
– Referred to better MD for intervention with
AODM.
• 6/13/2011 – improvement in fatigue. Labs
rechecked.
• 7/11/2011 – “feeling wonderful”
31. G.G. – labs before and after
4/11/11 interventions 7/11/11 changes
TSH 3.84 Raise T4 from 0.01 (L) none
50 – 75 ug
FT4 1.16 “ 1.24 “
FT3 2.8 “ 3.3 “
Progesterone <0.2 100mg topical 0.9 None
HS
Testosterone 11 4mg topical 15 4 mg LABIAL
DHEA-S 25 25 mg SR n/a continue
32. The glamorous grandmother – post tune-up
9/28/2011 (permission granted to use photos & data) 01/26/2012
33. One destigmatizing notion:
Estrogen as MAOI
• Estrogen & Testosterone (!) decrease
MAO
– Luin, VN. Brain Res. 1975;86:273-306
• Platelet MAO levels inversely
correlated to estradiol levels
– Klaiber EL et al. Psychoneuroendo-
crinology. 1997 Oct;22(7):549-58.
• Estrogen decreases MAO-A & MAO-B
– Holschneider DP et al. Life Sci. 1998;63(3):155-60
34. Estrogen-related mood disorders –
reproductive life cycle factors.
Douma SL et al. Adv. Nursing Sci. 2005. 28 (4):364-375
• “Clinical recovery from depression
postpartum, perimenopause, and
postmenopause through
restoration of stable/optimal
levels of estrogen has been
noted.”
35. Symptoms of estrogen imbalances*:
Hot flushes or flashes; night sweats
Mood swings
DEPRESSION, and/or anxiety, panic attacks
“Concentration” issues: Memory, communication,
and attention span loss, “brain fog.” (Think:
“MORE MAO.”)
Insomnia
Weight gain – “appetite changes”
SOMATIC symptoms : aches and pain
General deterioration: Incontinence, digestive
disturbances, sensory function loss, aging skin . . .
thinning, wrinkles, sagging* Adapted from Whitney Gabhart, N.D.
36. The Case of the Crying Cleaner
• 1/11/12 - Symptoms:
– Crying/depressed = on
Citalopram
– Hot flashes
– Night sweats
• RX:
– Estradiol – 2 mg @HS
– Prometrium – 100 mg
@HS
– (continue citalopram)
• 1/15/12 – RESOLVED
• IN 2 WEEKS!!!.
Photo & data used with permission
37. Psychoactive Progesterone*
Increases energy and libido
Has a calming effect, acting like a
benzodiazepine to the brain (HS dosing)
Enhances mood
Balances blood sugar (appetite)
Regulates fluid balance, sodium mineral balance
Necessary for fertility
Helps relieve menopausal symptoms
Decreases risk of endometrial cancer and may help protect
against breast cancer, fibrocystic breasts, and
osteoporosis * Adapted from Whitney Gabhart, N.D.
38. Testosterone: The “sexist” bias against women
(e.g., “your loss of sex drive is just natural for
your age.”)
• Fall in the circulating testosterone and the adrenal
preandrogens most closely parallel increasing
age.
• Accelerated decrease occurs in the years
preceding menopause (like estrogen).
• Their loss affects: libido, vasomotor symptoms
(hot flashes), mood, well-being, bone structure,
and muscle mass.
– Burd, Bachmann. Androgen replacement in menopause.
Curr Womens Health Rep. 2001 Dec; 1(3):202-5.
39. The Case of “Pajama Mama”
• 41 yo MWF, mother of three, ref by therapist for worsening depression.
History of chronic headaches. Mild dep symptoms x 16 years.
• CC: “I think I need a good medication, and I need to stay on it.”
• In normal mood state until after birth of second child 14 years prior (@
age 27)
– Recalls “calling the doctor all the time” and ego-dystonic worries of
dropping her baby over a railing ACCIDENTALLY on the stairway
at home
• RX tried
– fluoxetine– “worked reasonably well”
– Amitryptline for headaches – “knocked me out”
– Alprazolam – had her first panic attack ON IT.
– Tried on duloxetine – no relief.
• Rx at present – fluoxetine 20 mg; topirimate 100 mg, sumitriptatn as
needed
40. The Case of “Pajama Mama” - treatment
• Fluoxetine gave sexual side effects. Stopped.
Escitalopram now at 15 mg. Trazodone 25 mg HS..
– Topirimate continued for migraines.
• Psychotherapy: focused on significant dependent
personality disorder and on controlling, overbearing, free-
spending, financially irresponsible husband.
– Increasing limit setting noted. Patient reading her bibliotherapy
assignments
• Escitalopram didn’t work. Back to fluoxetine. IgG Food
sensitivities found; diet restrictions instituted.
• 11/15/2011 – working professionally in her field, has gotten
graduate degree, but tired and wrung out. Exhausted at
end of day. Was tired on a cruise vacation almost all the
time. Went back to room to sleep. Forcing self to
exercise.
42. This is what those labs “sound like”
• “I must be worse than I think I am, because my daughter made a
comment about the members of her family. ‘Mom likes her
pajamas.’”
• “I’m frustated that I’m not doing great – I don’t know why. There
should be no reason why I should think about the way I feel, or
wonder, ‘why don’t I want to get up?’ or ‘Why do I feel anxiety?’ I
don’t have to give a speech. I don’t have to do anything.”
• “I’ve done a lot of right things… I’ve done so many right things. I’ve
43. Pajama Mama – treatment and follow-up
• All psychotropics kept same
• Hormones added (11/15/2011):
– Testosterone – 10/mg/cc – ¼ cc labially daily -
increased to ½ cc (5 mg) labially per day.
– Amour thyroid – ¼ grain x 1 week, then ½ grain
– DHEA – 25 mg SR micronized daily in a.m.
• Still tired – 12/13/2011 –
– New RX: Hydrocortisone – 5 mg twice daily
added (a.m. and lunch)
44. PJ Mama – STABLE – 1/17/2012
• “I don’t have a hyperactive sense of energy, [but]
I’m no longer pajama mama [sic]. I just have the
energy to do what I’m supposed be doing, and
more, sometimes. But it’s not an odd, hyperactive
type thing.”
• Household budget now fixed and stable.
Increased limit setting with husband.
• “He has used anger to shut me down and shut me
out from day 1. He still uses anger, but instead of
me going away, he goes away. I don’t back
down.”
45.
46. Fast food (low Zn) is bad for you.
• Fast food = high energy density = low essential
micronutrient density, ESPECIALLY ZINC
• Antioxidant processes are dependent on Zinc
• Fast food = severe decrease in antioxidant
vitamins and zinc, correlating with
inflammation in testicular tissue – with
underdevelopment of testicular tissue and
decreased testosterone levels
47. Testosterone (Men)
• Decline in male sex steroids not as
abrupt as menopause, but equally
debilitating
–Between 40 – 70, average male
loses:
• Nearly 2" of height
• 15% of bone density
• 10 – 20 pounds of muscle
• At 70 yoa, 15% completely
impotent
48. T vs Cognitive Function
Rosario ER. JAMA. 292(2004):1431-2
49. T vs Cognitive Function
• 400 independently living men, 40-80yo
– 100 in each age decade
– MMSE 21-30, average 28
– TT: 208-1141ng/dL; Bio-avail T 78-470ng/dL
• HIGHER T = better cognitive performance in
OLDEST AGE category
• Men with lowest 1/5 T = worse than men with
highest 1/5 T
• Highest Bio-available T more significant
than TT, age, intelligence level, mood,
smoking, and alcohol.
Muller M. Neurology. 64(2005):866-71
50. T vs Mood in men
• Study: 278 men, >45yo, followed 2 years
• Compared to eugonadal patients,
hypogonadal men w/TT <200ng/dL had
– 4-fold increase risk of depression
– Significantly shorter time to depression
diagnosis
• Depression risk inversely related to TT
w/statistical significance <280ng/dL
Shores MM, Arch Gen Psychiatry. 61(2004):162-7
51. Testosterone and “Prostate Cancer risk”
• Prostate CA found 2.15 & 2.26 times more
likely in lowest compared to highest tertile
of total and free testosterone
• “. . . there are several papers showing a
relationship between LOW testosterone
and prostate cancer. Specifically, low
testosterone has been associated with
high-grade tumors, advanced stage of
presentation, and worse prognosis.”
Morgentaler A. Eur Urol. 50(2006):935-9
Morgentaler A. Urology. 68(2006):1263-7
52. The Case of the Mismanaged
Executive - summary
• 42 year old male ADHD CEO. Background in
psychology. Now EXTREMELY stressed.
• “So tired I feel like I’m dying.” “Depressed.”
• Lab findings – low testosterone, despite multiple
pumps of Androgel per day managed by
endocrinologist (!). Low thyroid. Low DHEA.
• RX: Testosterone cypionate IM – 60 mg twice
weekly. DHEA – 50 mg SR. Armour thyroid – ½
grain.
• Clinical status: total resolution of symptoms in 3- 4
weeks. No antidepressant used.
54. 50’ish year old female, post-
menopausal, on no hormones
• On aggressive supplement regimen with
daily MVI and others
• Not ill
• Top rated medical care with previous labs
done
• Nothing identified as seriously abnormal
• “Just interested in having my hormones
checked.”
55.
56.
57.
58.
59. Treatment for this “normal” patient
1. Armour thyroid – ¼ grain for 1 week, then ½
grain. (Aiming for T3 in “high 3’s” or OPTIMUM)
2. DHEA – 25 mg SR micronized, compounded – in
a.m.
3. Progesterone – 50 mg SR compounded – at
night.
4. Testosterone – 3mg topical per day x 1 wk, then
6 mg. “Decrease dosing as needed for side
effects.”
5. Vitamin D – 5,000 IU twice daily x 3 weeks, then
decrease to one dose per day.
6. High potency liquid fish oil – 4 grams per day
60.
61. What’s life like now?
• “it’s like the colors of the rainbow have gotten
more into the pink.”
• “My computer will survive – I use to ‘lose it’ over
my computer. I would swear obscenities.”
• “I’ve gotten into a zen like mode. Handling
everything that life can throw at me.”
• “It’s almost as if I’ve taken a pill or drug that jus
makes me handle everything that life is throwing at
me. I can roll with it.”
• “I’m not irritable any more. Time pressure has just
gone away.”
62. Key points
• A predominantly psychiatric view with
psychiatric interventions…
– Will not fix all symptoms
– Unlikely to get anybody else to do it for you,
either.
• STABILIZING THE BIOLOGICAL is critical
for full remission and total wellness when
hormones are not optimal.
• Holistic and integrated tx required.
• Yoking of thyroid, adrenal & sex steroids
63. HOW OBVIOUS DOES IT HAVE TO BE?
The Challenge of Empathic Listening
& CREATIVE THINKING
Ron Hunt lost an eye but suffered
no brain damage after a freak
accident with a large drill bit.
(ABCNEWS.com)
64. “Sit down before fact as
a little child,
be prepared to give up
every preconceived
notion,
follow humbly wherever
… nature leads,
or you shall learn
nothing.”
- Thomas H. Huxley
67. Dangers with
Psychiatry/psychotropics
• Failure to diagnose
– (E.g “head case” and then they die of a medical problem)
• Failure to adequately treat
• Failure to prescribe accurately (Rx-rx interaction)
• Giving people side effects
• Using the wrong drug
• Ignorance about best options because “I always did it that
way.”
• Getting people addicted
• Practicing beyond your ability and expertise
• Violating black box warnings
68. *ACCURATE MEDICAL diagnosis a malpractice suit
Depression & Anxiety & “mood disorder due to a
in 1 Easy Lesson
general medical condition” AND r/o bipolar disorder
DEPRESSION Gen. ANXIETY D.O.
SIG: E- CAPS! •Somatic Sx (“energy”,etc.)
• Sleep •WORRY
• Sadness •Irritability
• Interest loss •Concentration
• Guilt •Keyed up
• *Energy •Insomnia (“sleep”)
• Concentration •Restlessness
• Appetite BEWARE BEWARE – “too much”
• Psychomotor Sx energy
• Suicidal thinking SWICKIR is Quicker:
Worry + 3 = GAD (Baughman)
5of 9 with 1 of 2 x 2 weeks
69. Comorbidity of Depression and
Anxiety
Disability % Patients
Disabled 3+ Days
GAD + MDD 33.7%
MDD/no GAD 19.45%
GAD/no MDD 16.9%
no GAD/no MDD 3.1%
0 5 10 15 20 25 30 35 40 45
Percent of Patients With ≥1 Disability Day in Past Month
Wittchen, Depress Anxiety, 2002
71. Kids and Adults – Differences in
HYPERACTIVE domain
AS A CHILD: AS AN ADULT:
• Squirming, fidgeting • Work inefficiencies
• Cannot stay seated • Can’t sit through meetings
• Cannot wait turn • Cannot wait in line
• Runs/climbs excessively • Drives too fast
• Cannot play quietly • Self-selects very active job
• On the go/driven by motor • Cannot tolerate frustration
• Talks excessively • Talks excessively
• Blurts out answers • Makes inappropriate
• Intrudes, interrupts others comments
• Interrupts others
Sources: DSM-IV (TR). APA 2000:85-93)
Weiss MD, Weiss JR. J Clin Psychiatry 2004;65(Suppl 3):27-37.
72. Horrigan J, et al. Presented at 47th Annual AACAP Meeting:
October 24-29, 2000. New York, NY.
73. Persistence of ADHD Into Adulthood
• ADHD is a heterogeneous disorder associated with
considerable disability and comorbidity that, in many cases,
persists into adulthood1
– Some studies have found persistence as high as 36.3%2
• Mood, anxiety, and substance use disorders are
the most common comorbid disorders in adults with ADHD3
• Current prevalence of ADHD persistent into
adulthood 4.4%4
• Much of the treatment of adult ADHD can be based on
experience in treating children/adolescents5
1. Barkley et al. J Abnorm Psychol. 2002;111:279-289.
2. Kessler RC et al. Biol Psychiatry 2005 June;57(11):1442-51. [retrospective review of 3,197 14-44 yo
respondents in NCS-R]
3. Biederman et al. Am J Psychiatry. 1993;150:1792-1798. 4. Kessler et al. Am J Psychiatry.
2006;163(4):716-23. 5. Dodson WW. J Clin Psychol. 2005;61:589-606.
74. Diagnostic Pearls - Cady
• How’s work?
– How has your employment history been?
• How’s your mood? Your marriage (relationship)?
• How was school for you?
• Are people nervous driving with you?
• Are there periods of time when you have too much
energy for no particular reason?
• Do you ever have to have a beer at the end of the day to
relax?
– [gently lead in to other substances, especially stimulants that
may have a CALMING effect]
– “Have you ever taken any of your child’s ADD Rx?” [or other
stimulants, energy drinks, diet pills, or cocaine]
75. Failure to adequately treat
1. “Begin with end in mind.” (Covey)
2. Start LOW – (rule of thumb – ½ what the
drug rep and package insert says!)
3. Go up to the maximum tolerated dosage,
with finesse.
– Tell them about “Goldilocks”
4. If it doesn’t work, add something
complimentary (that makes sense).
76. THE FACTS
• SSRI’s treat depression AND/OR anxiety
• Patients may INITIALLY need something else for daytime
anxiety or sleep.
• BZD’s of choice:
– clonazepam 1 mg tablets – ½ to 1 twice daily to three
times daily
– Diazepam – 5 mg =- ½ - 1 ½ twice daily to three times
daily
• (first pass and second pass effects)
• ANTIANXIETY RX (non BZD) – Buspirone, per package
insert. Push to 20 mg THREE TIMES DAILY or to the
point of maximum tolerability for 4 – 6 weeks AT THAT
DOSE.
– Start with 5 mg. Can use WITH SSRI’s
77. AVOID Alprazolam (Xanax ®)
• Addicting (and rapidly so)
• Can have seizures if rapidly withdrawn
(structurally similar to carbamazepine)
• MD’s shot over it.
• NOT an “anti-anxiety” medication
• NOT a sleeper.
• Even if they need a BZD for anxiety, it
doesn’t have to be Xanax.
78. Sleepers – my preferences
• Sleepers:
– Rozerem (brand) (a melatonin analog) – 8 (up to 16* mg) at
bedtime. VASTLY under-rated. May need to take 2 weeks before
adequate effect. (* off-label dose)
• Dual acting agent – homeostatic and circadian effects. 70x as potent
as melatonin.
– Trazodone (50 – 150mg ½ - 2 hrs before HS. (Note, off label
“unapproved.” Warn on priapism).
– Lunesta (brand) – 2 – 3 mg. Try samples. Have mouthwash on
hand. (Probably most predictable agent)
– Ambien 12.5 mg CR (brand) – legitimately lasts longer than
zolpidem. Probably not as effective as Lunesta.
– Zolpidem – generic. People get hooked on it.
• Paradigm: SYMPTOMATIC treatment – after
depression is stabilized, fade out the sleeper
85. “Strattera [coupled with Prozac
or Paxil] has been great for
our admissions.”
-Dr. William Beute, MD
Pine Rest Campus Clinic
Grand Rapids, MI
April 21, 2004
[quoted with permission]
86. Cytochrome p-450 2D6 inhibition measured as %
increase in “Desipramine AUC” – in vivo data
Critically important when
combining with other Rx
metabolized through 2D6
pathways
Preskhorn, Alderman, et al. Pharmacokinetics of desipramine coadministered
with sertraline or fluoxetine. J. Clin Psychopharmacol 1994;14:90-98;
Escitalopram package insert - note – different source of data, but same method
88. The “not so selective” SSRI’s; how to
“Do yourself a favor.”
drug SSRI? 2nd order effects Side effects possible
Escitalopram Yes NOTHING (excess serotonin side
(Lexapro) now effects only)
generic
Sertraline (Zoloft) Yes Dopamine (1/3 as Agitation, nervousness;
potent as improved [ ]
amphetamine)
Citalopram Yes AntiH1 Sedation (note- FDA
(Celexa) lowered max dose to
40mg)
Paroxetine (Paxil) Yes Ach Doped up, TCA effects,
NOT “NRI” neurocognitive problems,
withdrawal. Sexual,
Prostate sxs
Fluoxetine Yes 5HT2C Agitation, appetite
(Prozac) suppression
89. New Agents, New Mechanisms
(agent) (MOA) Differentiating points
Venlafaxine (“IR” and XR) SSRI, NRI Nausea, GI side effects, sxl
(Effexor) dysfunction
Duloxetine (Cymbalta) SSRI, NRI Same. Better tolerated. For pain
w/ dep.
Desvenlafaxine (Pristiq) SSRI, NRI Better tolerated
Trazodone XR with 5HT2a/c
Contramid® (OLEPTRO) BLOCKER, mild
SSRI
Vilazodone (Viibryd) SPA, SSRI ONLY SPA. Weaker SSRI.
Targets 5HT1A. Less sexual side
effects.
Bupropion (“XL” – not “NDRI” Possibility of anxiety & “wound
“SR”) (Wellbutrin) up.” Improved concentration.
Push to 450 mg. Seizures.
90. Duloxetine (Cymbalta) Versus
Escitalopram (Lexapro) and Placebo:
An 8-month, Double-Blind Trial in
Patients With Major Depressive
Disorder
Pigott et al., Curr Med Res Opin, 2007
91. Comparison of Escitalopram and Duloxetine:
HAMD (MMRM)
8-Month Trial
17
Subscales
Anxiety/
Total Score Sleep Maier Retardation
Somatization
*
*p<0.05
Pigott et al., Curr Med Res Opin, 2007
92. Comparison of Escitalopram and Duloxetine: 8-
Month Trial
Significantly Different Adverse Events (p<0.05 Duloxetine vs Escitalopram)
Percent of Patients
Pigott et al., Curr Med Res Opin, 2007
93. Comparison of Escitalopram and
Duloxetine: 8-Month Trial
Conclusions
• Remission rates for both escitalopram and duloxetine
continued to improve over time
• Significantly more escitalopram-treated patients
continued treatment compared to duloxetine-treated
patients
• Escitalopram showed significant improvement vs
duloxetine on the HAMD17 sleep subscale
• Compared to escitalopram, duloxetine significantly
increased pulse and systolic blood pressure
Pigott et al., Curr Med Res Opin, 2007
94. Two New Agents You Need to Know
• Extended release Trazodone
– NOT “son of Trazodone”
– Possibility of legitimate antidepressant effect with anti-
anxiety effect WITHOUT doping patient up.
– A “SARI” – serotonin antagonist reuptake inhibitor
• Vilazodone – the only SPARI available.
• How to appreciate:
– 5HT1A is receptor for antidepressant effect of serotonin
– 5HT2A and 5HT2 C: anxiety, sleep disruption, sexual
side effects.
– ANYTHING which works preferentially on 5HT1A is
GOOD!
95. XR Trazodone steady state dosing study
• (Levels done after 7
days steady state)
• 300 mg XR Traz
AUC comparable to
100 mg IR Traz tid
• Cmax 42% lower
than IR Trazodone
– Translation – it
doesn’t dope the
patient up.
Kramer, WG et al. Once-daily Trazodone: Overview of Pharmacokinetic Properties.
Poster – ACCP 38th Annual Meeting, San Antonio, TX 2005
96. XR Trazodone Food Effect Study
• PI says “take at night”
• CMax increase by 86%
(!!!) under fed conditions.
Peak is at 7 hours post
dose (with feeding).
• Note – this may lead the
enlightened prescriber to
vary the time of dosing.
Kramer, WG et al. Once-daily Trazodone: Overview of Pharmacokinetic Properties.
Poster – ACCP 38th Annual Meeting, San Antonio, TX 2005
97. Vilazodone – a SPARI (per Stephen Stahl, MD, Ph.D.) –
Serotonin Partial Agonist Reuptake Inhibitor
• Highly serotonergic. START LOW (5 mg).
• Because of 5HT1A agonism, LESS “SSRI” effect is
required.
98. ADHD Rx for frontline medicine
• Desiderata – get control, and keep it consistent for
predictable period of time
• Rules of thumb: don’t be guided on SIZE. START LOW.
“Know the Biederman max” for MPH and amphetamine.
• Recommendations (for children and adult):
– Focalin XR (Dexmethylphenidate XR) 5,10,15,20,30 and 40 mg
capsules)
• Rationale: MPH based. FAST. 8 – 10 hours. Can dose twice daily (off-
label), a.m. >pm. (can also start with ½ capsule)
– Vyvanse – (lisdexamfetamine [sic]) – 20,30,40,50,60,70 mg [= 7.5
– 30 mg] amphetamine equivalents. Lasts 12 – 14 hours. (Can
dissolve in water – per PI!).
– Kapvay/Intuniv – FDA approved in kids.
• Kapvay easier to use, better tolerated.
• Intuniv more potent, but more side effects (sedation)
99. Practicing beyond your ability (and knowledge) –
the second generation antipsychotics
• Definitions:
– Mood stabilizer – something that stabilizes mood
(Lithium, carbamazepine, VPA)
– Antipsychotic – something you give someone who is
PSYCHOTIC to get them UNPSYCHOTIC.
– Antidepressant – something for depression.
– “2nd generation antipsychotic (“SGA’s”) = S2/D2
blockers.”
• Can “stabilize mood” as well as function as antipsychotics
• Now some FDA approved for either add-on use or single agents
for “bipolar depression” (e.g., quietapine XR)
100. Know who you’re playing with
• SGA’s and WEIGHT GAIN (Cady experience)
– olanzapine/risperidone > quietapine>
aripiprazole/arsenapine> lurasidone/ziprasidone
• (Zyprexa/Risperdal>Seroquel> Abilify/Saphris> Latuda/Geodon)
• EXPENSIVE: $400 – $600 /per month
• All will work for mania. NONE are pure “mood stabilizers.”
Some make you fat.
• Some will work for depression but dope you up.
• Much less risky than 1st generation for tardive dyskinesia.
• Axiom: refine your psychopharmacology before going to
look for an SGA.
• If you have to use one (for bipolar or psychosis, Lurasidone
is probably most benign – 40 – 80 mg twice daily)
101. Cady recommendation for SGA’s in
primary care
• As little as possible.
• Do NOT use as primary mood stabilizers for bipolar
disorder. Use lithium and/or VPA. (And check levels and
appropriate labs). Lamotrigine also a real option.
• Can use if single, or better yet, DOUBLE mood stabilizers
don’t work.
• Abilify (only “dopaminergic” SGA) probably best for
antidepressant augmentation.
– 2 – 4 or 5 mg is optimum dose for this. (Start with ½ of a 2 mg and
go up)
– Onset is FAST when it happens.
• Olanzapine is most dependable for rapid onset and control
of manic episode, or agitation, or EXTREME PANIC &
anxiety (off label).. Lurasidone may be best tolerated.
102. “There are things
known and there are
things unknown, and
in between are the
doors.”
- Jim Morrison
104. Contact information:
Louis B. Cady, M.D.
www.cadywellness.com
www.indianaTMS-cadywellness.com
Office: 812-429-0772
E-mail: lcady@cadywellness.com
4727 Rosebud Lane – Suite F
Interstate Office Park
Newburgh, IN 47630 (USA)
Editor's Notes
Depressed mood is the most commonly cited symptom in major depressive disorder. Studies have shown that fatigue and reduced energy are nearly as common as depressed mood. As many as 94%-97% of patients may experience reduced energy and fatigue, while 73% may complain of tiredness. Impaired concentration is also common and occurs in as many as 84% of patients. Hypersomnia, or excessive sleepiness as opposed to physical weariness, is less common and occurs in 10%-16% of patients.
Addison ’s disease, like so many medical conditions, has a history of being ignored, hidden, and misunderstood. It is a rare disease that affects about one in every 100,000 Americans and is usually diagnosed around age forty.
These symptoms correlate to decrease in bioavailable testosterone
RIA (in-house after diethylether extraction) Total testosterone - T (RIA) 208-1141ng/dL, average 536+/-153ng/dL Bioavailable testosterone - BT (calculated) 78-470ng/dL, average 236+/-63ng/dL
Hypogonadal if TT < 200ng/dL or FT < 0.9ng/dL
Both MDD and GAD are associated with considerable functional impairment and disability. Comorbid depression and GAD tends to result in greater levels of disability as measured by the proportion of patients who report 1 or more days of disability in a 30-day period. Patients experience diminished functioning both at work and socially, with many reporting moderate or severe social disability. Reference Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety . 2002;16:162-171.
ADHD is a heterogeneous disorder associated with considerable disability and comorbidity that, in many cases, persists into adulthood. 1 Mood, anxiety, and substance use disorders are the most common comorbid disorders in adults with ADHD. 2 ADHD in adults is more prevalent than once thought. The National Comorbidity Survey found the estimated lifetime prevalence of ADHD in adults to be 8.1%. 3 According to DSM-IV criteria, adults diagnosed with ADHD must have had childhood onset and persistent and current symptoms, although allowance is made for partial remission. 4 Due to the great syndromatic continuity between childhood and adult ADHD, much of the medication management of adults with ADHD can be based on the experience gained from treating children and adolescents. 5 Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnormal Psychol. 2002;111:279-289. Biederman J, Faraone SV, Spencer T, et al. Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry . 1993;150:1792-1798. Kessler RC, Berglund P, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry . 2005;62:593-602. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 4th ed. ( DSM-IV ). Washington, DC: American Psychiatric Association; 1994:78-85. Dodson WW. Pharmacotherapy of adult ADHD. J Clin Psychol . 2005;61:589-606.
In a flexible dose study evaluating the safety and efficacy of escitalopram in the treatment of panic disorder (with or without agoraphobia), outpatients were randomized to receive placebo, citalopram or escitalopram. There were approximately 120 patients per treatment group. Following a 2-week single-blind lead-in period, patients received 10 weeks of double-blind treatment. Treatment was initiated at a low dose (10 mg/day for citalopram and 5 mg/day for escitalopram) and then titrated after one week to 20 mg/day for citalopram and 10 mg/day for escitalopram. After week 4, dose could be increased to 40 mg/day citalopram and 20 mg/day citalopram. The Panic and Anticipatory Anxiety Scale (PAAS) and the Panic and Agoraphobia (P&A) scale were used to quantify panic attacks, anticipatory anxiety, and phobic avoidance.
Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin. 2007 Apr 27;
Overall effects of treatment of depression were assessed by the HAMD 17 total score using MMRM analysis. Treatment effects related to the somatic symptoms associated with depression were assessed by the anxiety/somatization subscale that consists of HAMD 17 items 10 (psychiatric anxiety), 11 (somatic anxiety), 12 (gastrointestinal-related symptoms), 13 (general somatic symptoms), 15 (hypochondriasis), and 17 (insight). The sleep subscale (HAMD 17 items 4, 5, and 6) was used to assess the treatment effects on insomnia (initial, middle, and terminal). The Maier subscale measures the core symptoms of depression and comprises HAMD 17 items 1 (depressed mood), 2 (feelings of guilt), 7 (work and activities), 8 (retardation), 9 (agitation), and 10 (psychic anxiety). The impact of treatment on energy and interest levels was evaluated by the retardation subscale: HAMD 17 items 1 (depressed mood), 7 (work and activities), 8 (retardation), and 14 (genital symptoms). After 8 months of treatment, duloxetine (60-120 mg/day) and escitalopram (10-20 mg/day) showed similar efficacy on HAMD 17 total and subscale scores, except the sleep subscale. On the HAMD 17 sleep subscale, escitalopram was significantly more efficacious than duloxetine (p<0.05). Rates of remission were not significantly different between escitalopram and duloxetine over the 8-month course of the study (50% vs 47%; respectively). Because so few patients on placebo (n=15) completed the entire 8-month study, the power to detect a difference between placebo and active treatments after 8 weeks was significantly decreased and very likely to be insufficient. Reference Pigott TA, Prakash A, Arnold LM, Aaronson ST, Mallinckrodt CH, Wohlreich MM. Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin . 2007;23(6)1303-1318.
This slide shows the adverse events that were significantly different between escitalopram and duloxetine. Nausea, dry mouth, vomiting, yawning, and night sweats were reported at a significantly higher rate with duloxetine than with escitalopram, whereas only migraine was more frequently reported in the escitalopram group than in the duloxetine group. References: Pigott TA, Prakash A, Arnold LM, Aaronson ST, Mallinckrodt CH, Wohlreich MM. Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin . 2007;23(6)1303-1318.
Throughout this 8-month extension study, escitalopram and duloxetine showed similar efficacy on all study measures except on the HAMD 17 sleep subscale. On the HAMD 17 sleep subscale, escitalopram was significantly more efficacious than duloxetine. Remission rates between escitalopram and duloxetine were not significantly different and both treatments lead to continued improvement over time. Significantly more escitalopram-treated patients continued treatment compared to duloxetine-treated patients, and duloxetine treatment led to an increase in both pulse and systolic blood pressure. References: Pigott TA, Prakash A, Arnold LM, Aaronson ST, Mallinckrodt CH, Wohlreich MM. Duloxetine versus escitalopram and placebo: an 8-month, double-blind trial in patients with major depressive disorder. Curr Med Res Opin . 2007;23(6)1303-1318.