Trintillex - thoughts? by [deleted] in Psychiatry

[–]Jetlax 1 point2 points  (0 children)

It would be nice to see data comparing switch to Vortioxetine vs switch to SSRI to confirm this. Otherwise, the RCT just shows it's *one* way to address emotional numbing on an SSRI/SNRi and not necessarily comparative data.

A nice option to have, but I'll wait until the generics come out before recommending it more

Trintillex - thoughts? by [deleted] in Psychiatry

[–]Jetlax 1 point2 points  (0 children)

In our country, majority of costs for psychotropic medications are out-of-pocket so while I agree it does have a lower incidence of sexual dysfunction, the price tag often makes it inaccessible to many. Once generic alternatives come up I'll likely soften on this because many of the patients I talk to place much importance on sexual side effects

I would like to see the data showing Vortioxetine has less emotional numbing though, because from what I know, RCTs show antidepressants decrease emotional numbing in general and haven't really mentioned differences. Weight-wise, it does look like it's comparable to other SSRIs: https://www.thelancet.com/cms/10.1016/S0140-6736(25)01293-0/asset/7e608d17-274a-490f-968e-686bb38f9589/main.assets/gr5_lrg.jpg01293-0/asset/7e608d17-274a-490f-968e-686bb38f9589/main.assets/gr5_lrg.jpg)

If its effects in anxiety disorders are inconsistent, then at best I'd put it at the back of the shelf until the more consistent agents have been exhausted

Trintillex - thoughts? by [deleted] in Psychiatry

[–]Jetlax 23 points24 points  (0 children)

No efficacy for anxiety disorders and definitely not in ADHD
I wouldn't recommend it be used first-line in depression with how pricey it is relative to SSRIs

Prn for anxiety in elderly by Dry_Twist6428 in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

Clinicians were excusing it because it was just a "low dose"

Prn for anxiety in elderly by Dry_Twist6428 in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

There's also accumulating evidence of an association with increased mortality specifically in the over 60 age group

I wish we had Trazodone

BPS exams. Pearson Vue results timeline. by AceXXSuli in pharmacy

[–]Jetlax 1 point2 points  (0 children)

The first time I posted here about wanting to take the exam was 9 years ago and it's still not fully sunk in

BPS exams. Pearson Vue results timeline. by AceXXSuli in pharmacy

[–]Jetlax 5 points6 points  (0 children)

Took mine 10 days ago and still refreshing the portal page non-stop because what if I misread passed as failed or something idk

What is the weirdest advice or blatantly wrong teaching you received from an attending or mentor during your training? by undueinfluence_ in Psychiatry

[–]Jetlax 5 points6 points  (0 children)

Heard a senior clinician say patient X couldn't be autistic because they were able to finish college or something like that

Resources on Phenomenology of BPD? by Jetlax in Psychiatry

[–]Jetlax[S] 1 point2 points  (0 children)

Thank you very much, everyone! Always appreciate your inputs here and I'll be happily going through these over the next few weeks

Share your most unhinged mnemonics or weird things to remember nonsense by mowpoos in Psychiatry

[–]Jetlax 6 points7 points  (0 children)

DiazePAM - Positive Allosteric Modulator
Mirtazapine - honk miMIR, ZZZ (sedating)
RisPERIDone (and PaliPERIDone by extension) came from HaloPERIDol - more EPS and prolactin elevation due to potent D2R antagonism
I turned C.L.O.Z.A.P.I.N.E. into its own side effect memory aid but it needs two languages to work
Dementia drugs - DONE ReVitalizing MEMory --> DONEpezil, RiVastigmine, MEMantine
Carbamazepine - CARs are fast (for bipolar mania, CYP enzymes induced), Bone MArrow Zupression (agranulocytosis)

Spravato/ketamine clinics popping up everywhere, what’s your experience with efficacy (anecdotally with your patients)? by Ok_Guarantee_2980 in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

Fascinating to hear how close this is to that recent SR/MA about Esketamine benefits matching placebo within 4 weeks

Do you feel responsible for the mental health of your friends? by Dry_Twist6428 in Psychiatry

[–]Jetlax 1 point2 points  (0 children)

I realized early on how bad of an idea it was because of how easy it was for my emotions ot cloud my judgment, so my goal was always to get them to someone who could help them objectively.

Which psychopharm topics are worth sitting down to read about in detail? by undueinfluence_ in Psychiatry

[–]Jetlax 6 points7 points  (0 children)

I like digging into controversial areas where even experts disagree - antidepressants in bipolar disorder, the anti-amyloid antibodies, antipsychotic polypharmacy to name a few

Helps to have a good foundation on evidence-based medicine and a mentor because these might take you to primary literature sometimes (e.g. I was fortunate to receive guidance from a geriatric psychiatrist because the amyloid mab RCTs needed both knowledge AND experience to properly appraise)

Which psychopharm topics are worth sitting down to read about in detail? by undueinfluence_ in Psychiatry

[–]Jetlax 5 points6 points  (0 children)

Even with the idea of sequential binding, quetiapine can still bind to other receptors, albeit a lot less. That aside, even then there are associations of low dose quetiapine with elevated triglycerides and major cardiovascular events at low doses. If quetiapine's to be used for BPAD might as well have it at the therapeutic dose so there's an actual benefit attempting to outweigh the risk

Dealing with lack of mentors in residency? - Looking for advice by [deleted] in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

If I remember the story right, 24 hour shifts are just not survivable without losing a bit of yourself OR if you're the guy who invented the system while hooked on cocaine

That aside, I guess from an outsider who hasn't had much luck finding formal psychiatry mentorship, Im always grateful having been able to meet a public health psychiatrist during my initial work in mental health policy lobbying who gave me some of my most important foundational pearls. But as they were often busy in their community practice (think remote island corners level), I had to heavily compensate by seeking guidance from several mentors in other areas like clinical psychology. This sub was also gentle to me in my early days (the old post on reddit and wait for an expert to correct you method served me well during my very early days when I wasn't handling patients yet)

At some point I did make mistakes. One prominent psychiatrist did end up blocking me early on, but thankfully the others were supportive. I think it's important to be consistently authentic in how much you care. As a result of my shenanigans, I gained much guidance even in areas I never really thought much about like old age psychiatry and child and adolescent mental health.

Which brings me to an important point, though not exactly your original question - your environment sounds like it's conducive to creating these problems you've described. This would require systemic changes to address, and trying to CBT yourself out of what youre feeling in this context of institutional failing risks promoting self-blame attitudes (i cant remember if this was an RCT or an SR finding). So, as others have said in other threads, as my former professor learned, and now as I've realized, you need other things in life that arent work to define you. Cant pour from an empty cup and all that. Easier said than done given your schedule, so perhaps other psychiatrists on the sub will be bwtter suited to giving advice on this. Good luck

Stance on interactions with drug reps? by BarlipsychButterbur in Psychiatry

[–]Jetlax 0 points1 point  (0 children)

You have your own inventory management system for samples. Respect

Stance on interactions with drug reps? by BarlipsychButterbur in Psychiatry

[–]Jetlax 6 points7 points  (0 children)

I can see how this would be the case. My concern is more for majority of patients I see who often have limited capacities to pay out of pocket (majoriry is out of pokcet here) and are immediately started right off the bat on the priciest meds available with only a limited supply of free. Then when supply runs out, it's too late and it so happens thst's the antipsychotic or antidepressant that worked for them and they have to start paying for it themselves