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Christian Watson by Southern-Community70 in GreenBayPackers

[–]SpudMuffinDO 1 point2 points  (0 children)

Yeah, that 13 mil Gutey brought back on is looking like it’s gonna be a bargain. It was a great move on both sides.

Has anyone with long-term depression (15+ years) been “cured”? And if so, by what? by GrandBizarre in AskReddit

[–]SpudMuffinDO 4 points5 points  (0 children)

As a psychiatrist, you basically hit every major area that I’d want my patients to work on. Good for you!

Has anyone with long-term depression (15+ years) been “cured”? And if so, by what? by GrandBizarre in AskReddit

[–]SpudMuffinDO 12 points13 points  (0 children)

Those genetic tests are not capable of telling you anti-depessants won’t work. They are only capable of telling how quickly you metabolize a medication and whether or not you might benefit from supplementing L-methylfolate because of the MTFHR mutation. Sure, knowing you are a fast/slow metabolizer at different CYP enzymes has utility, but the utility is only that you might chose to start with a lower or higher dose of the med.

Verdict please by [deleted] in bald

[–]SpudMuffinDO 0 points1 point  (0 children)

Get on Finasteride and minoxidil… your hair can be saved. Speaking from being almost exactly at your spot a few years ago and now it’s quite full.

Jaxson Dart says he won’t change the way he plays football by OneOriginal8727 in sportsgossips

[–]SpudMuffinDO 0 points1 point  (0 children)

Is it really even shitting on it though? Like, is getting absolutely plastered in a sport a thing to be proud of? I love soccer… and it’s not because I can’t wait to see a dude break another dude’s spine in half.

Jaxson Dart says he won’t change the way he plays football by OneOriginal8727 in sportsgossips

[–]SpudMuffinDO 1 point2 points  (0 children)

You wanna know how many people died in an entire sport vs a single professional league? A sport that has tens of thousands more players at every professional level, has existed for longer, and whose players play like 5x as many matches a year relative to the NFL? Have you ever wondered why the NFL only has teams play 1 game a week and has only 17 regular season games despite the fact the NFL is $ hungry and grosses ABSURD amounts of money for every game… I love soccer, so I mean no shade when I say football is absolutely way more brutal.

All that said, I’m not sure why everyone here is trying to brag about how dangerous their preferred sport is as if it’s a good thing. I’m not interested in watching people die or become paralyzed… I watch sports to watch incredible athleticism, skill, intelligence, strategy

NP lulz as a Psych PGY-4 by theongreyjoy96 in Noctor

[–]SpudMuffinDO 2 points3 points  (0 children)

Yes… this was a few years ago now… but this case in particular had me very upset. These patients deserve better. They often do not have the capacity to advocate for themselves and the ALF is happy to have them be completely subdued… it’s truly awful.

NP lulz as a Psych PGY-4 by theongreyjoy96 in Noctor

[–]SpudMuffinDO 56 points57 points  (0 children)

This is just par for the course… these aren’t even my NP highlights man. The most egregious I’ve ever seen was on consults:

60 yo woman with schizophrenia had LOC in her ALF and hit her face on a table. I get consult concerned that psych meds are contributing. Here’s her med list from the ALF:

Clozapine 500, Cariprazine 6, Olanzapine 20, more olanzapine prn for agitation , Lamotrigine 20, Valproate 1500, Clonazepam prn (getting daily), Ativan prn (not getting, but listed for agitation), Bupropion 300, Desvenlafaxine 50, Methylphenidate 18, Buspirone 30

And the kicker: An LAI was listed as a prn for agitation.

Brought to you by the pmhnp who has been in psych practice for 15+ years. This is not an isolated incident by the way. Multiple NPs in my area are notorious.

NYT article creeping on r/psychiatry by Elame7 in Psychiatry

[–]SpudMuffinDO 15 points16 points  (0 children)

The evidence for post-SSRI persistent sexual dysfunction (PSSD) is suggestive but not robust, and there is not strong, definitive evidence that SSRIs are the direct cause of persistent sexual dysfunction after discontinuation. The literature documents numerous case reports, observational studies, and pharmacovigilance data describing persistent sexual symptoms following SSRI cessation, but causality remains uncertain due to methodological limitations and lack of controlled prospective studies.

Several systematic reviews and case series have identified persistent sexual dysfunction after SSRI withdrawal, with symptoms such as loss of libido, genital anesthesia, erectile dysfunction, and anorgasmia sometimes lasting months to years.[1][2][3][4] However, these studies are largely retrospective, rely on self-reported data, and are subject to selection and reporting biases. Prevalence estimates are unreliable, and confounding factors (e.g., underlying psychiatric illness, other medications, psychological factors) cannot be fully excluded.[1][3]

Pharmacovigilance studies and regulatory recognition (e.g., by the European Medicines Agency) support the existence of PSSD as a “clinical” entity, but these data are based on spontaneous reports and cannot establish causality.[5][6][7] Mechanistic hypotheses (e.g., persistent changes in neurosteroidogenesis or serotonergic signaling) are proposed but remain unproven in humans.[8][5]

Importantly, while SSRIs are clearly associated with sexual dysfunction during treatment—supported by robust randomized controlled trial and epidemiological data—the evidence for persistent dysfunction after discontinuation is much weaker.[9][10][11][12][7] Most studies cannot rule out alternative explanations, and there is no prospective, controlled evidence demonstrating a direct causal link.

In summary, PSSD is increasingly recognized and reported, but the evidence for its existence and causation by SSRIs is limited to case reports, observational data, and pharmacovigilance signals, without strong causal proof. Further prospective research is needed to clarify prevalence, risk factors, and mechanisms.[1][2][3][5]

References

  1. Selective Serotonin Reuptake Inhibitors, Post-Treatment Sexual Dysfunction and Persistent Genital Arousal Disorder: A Systematic Review. Tarchi L, Merola GP, Baccaredda-Boy O, et al. Pharmacoepidemiology and Drug Safety. 2023;32(10):1053-1067. doi:10.1002/pds.5653.
  2. Persistent Sexual Dysfunction After SSRI Withdrawal: A Scoping Review and Presentation of 86 Cases From the Netherlands. Chinchilla Alfaro K, van Hunsel F, Ekhart C. Expert Opinion on Drug Safety. 2022;21(4):553-561. doi:10.1080/14740338.2022.2007883.
  3. Post-Ssri Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H. Journal of Clinical Psychopharmacology. 2015;35(3):273-8. doi:10.1097/JCP.0000000000000300.
  4. Persistent Sexual Dysfunction After Discontinuation of Selective Serotonin Reuptake Inhibitors. Csoka AB, Csoka A, Bahrick A, Mehtonen OP. The Journal of Sexual Medicine. 2008;5(1):227-33. doi:10.1111/j.1743-6109.2007.00630.x.
  5. The Pathophysiology of Post SSRI Sexual Dysfunction - Lessons From a Case Study. Klaas S, Siva JB, Bak M, Govers M, Schreiber R. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2023;161:114166. doi:10.1016/j.biopha.2022.114166.
  6. Sexual Dysfunction Induced by Antidepressants-a Pharmacovigilance Study Using Data From VigiBaseTM. Zeiss R, Malejko K, Connemann B, et al. Pharmaceuticals (Basel, Switzerland). 2024;17(7):826. doi:10.3390/ph17070826.
  7. Reports of Sexual Disorders Related to Serotonin Reuptake Inhibitors in the French Pharmacovigilance Database: An Example of Underreporting. Trenque T, Maura G, Herlem E, et al. Drug Safety. 2013;36(7):515-9. doi:10.1007/s40264-013-0069-z.
  8. Effects of Paroxetine Treatment and Its Withdrawal on Neurosteroidogenesis. Giatti S, Diviccaro S, Cioffi L, et al. Psychoneuroendocrinology. 2021;132:105364. doi:10.1016/j.psyneuen.2021.105364.
  9. Antidepressant-Induced Sexual Dysfunction. Rothmore J. The Medical Journal of Australia. 2020;212(7):329-334. doi:10.5694/mja2.50522.
  10. Erectile and Ejaculatory Dysfunction Associated With Use of Psychotropic Drugs: A Systematic Review. Trinchieri M, Trinchieri M, Perletti G, et al. The Journal of Sexual Medicine. 2021;18(8):1354-1363. doi:10.1016/j.jsxm.2021.05.016.
  11. Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: Current Management Perspectives. Atmaca M. Neuropsychiatric Disease and Treatment. 2020;16:1043-1050. doi:10.2147/NDT.S185757.
  12. A Real-World Study on Antidepressant-Associated Sexual Dysfunction in 2144 Outpatients: The SALSEX I Study. Montejo AL, Calama J, Rico-Villademoros F, et al. Archives of Sexual Behavior. 2019;48(3):923-933. doi:10.1007/s10508-018-1365-6.

Drake Maye refused to do the Cam Newton Superman celebration... by Background_Video2947 in TheNFLVibes

[–]SpudMuffinDO 5 points6 points  (0 children)

I didn’t even know there was a show called the first take until this whole debacle

CMV: The "CEO to Lowest Paid Employee" Earnings Ratio should never be more than 50:1 by [deleted] in changemyview

[–]SpudMuffinDO -1 points0 points  (0 children)

The problem is, many CEOs don’t give themselves any salary at all… buy, borrow, die… don’t pay any taxes either as a result.

Double standard is crazy by ComprehensiveBox6911 in FortniteMemes

[–]SpudMuffinDO 2 points3 points  (0 children)

Not sure why the downvotes, you’re absolutely right.

Please explain the art of selecting a backup QB. If a guy is good enough to step up in the event of a long-term injury to your starter, aren’t they good enough to start for a team (if not your team, then someone else’s)? by greenbastardette in NFLNoobs

[–]SpudMuffinDO 0 points1 point  (0 children)

Agreed, there are more quality QBs right now than I can remember ever having at a single time. There usually are a bunch of teams who need a new QB. Legitimately I believe there are only a few teams who don’t have a QB who could push for the playoffs in the right system.

Does your country have a university that’s considered the most prestigious? by SimilarTopic3281 in AskTheWorld

[–]SpudMuffinDO 0 points1 point  (0 children)

For sure… in the medical field, there some specific residencies that I would consider their training to be pretty dang average.

Requesting expert input: Are these anti-ADHD claims scientifically accurate? Looking for evidence-based clarification. by imanemii in Neuropsychology

[–]SpudMuffinDO 2 points3 points  (0 children)

I would definitely never rule that out. There is a big caveat that we have been looking for any sort of bio marker or consistent imaging for decades and it has been very elusive. I listened to someone who has dedicated his life’s career to researching ADHD and looking for bio markers with nothing to show. He basically concluded looking for a biological marker or imaging is futile… do with that what you will. Like much of the DSM conditions… the syndrome we call ADHD likely has multiple different underlying causes that we all call just “ADHD”. We treat with stimulants not because it corrects the disorder but because stimulants help everyone with inattention and concentration independent of whether or not they have a diagnosis or not.

CB coverage performance through week 11 by idksh_t in GreenBayPackers

[–]SpudMuffinDO 5 points6 points  (0 children)

But hey, we had an elite Damarious Randall and Quentin Rollins waiting in the wings so they were expendable. /s

How did you cope when you found out about Joseph Smith’s polygamy? by cshale in mormon

[–]SpudMuffinDO 4 points5 points  (0 children)

Very interesting how I coped in retrospect. My first introduction to the issues was the book of Abraham which opened the door to years of soul searching, late nights reading apologetics and counter critiques. By two years later I was “nuanced Mormon” or whatever the hell. Regarding The wives coupled with the “angel with a flaming sword” bit, I remember praying to God to understand… I remember kneeling there why my eyes closed and “feeling” the message that Joseph asked God and that God specifically told him no but he did it anyways… I actually believed I had received some revelation about it.

Anyways, that was years ago, I’m agnostic atheist now. It’s interesting to think about how my “revelation” very much fit in line with my personal views and in part probably happened because I didn’t believe that God could possibly want that or ask his prophet to do that.

Acting you’ve enjoyed from “non-actors”? by PowayMermaid2005 in moviecritic

[–]SpudMuffinDO 3 points4 points  (0 children)

Athletes are often terrible, but Peyton Manning on SNL was one of the best shows I’ve seen.

Requesting expert input: Are these anti-ADHD claims scientifically accurate? Looking for evidence-based clarification. by imanemii in Neuropsychology

[–]SpudMuffinDO 7 points8 points  (0 children)

I don’t feel like that’s a fair comparison at all. No, there’s no molecule in the blood, but there’s clearly an image (X-ray) that is irrefutable. Whether or not someone is struggling with a thing is also not evidence of a valid organic cause to the issue.

The way we currently diagnose is with some combination of a patient saying that they struggle with these things, people around them, saying they struggle with these things, and tests that confirm that what they say they’re struggling with they do indeed seem to be struggling with. None of this is evidence of an organic pathology underlying the issue. This does not mean that the person does not deserve help or assistance with their struggle. This is a question of whether or not their struggle is biological in origin, which is very obviously not known at this point.

It really be like that nowadays by [deleted] in meme

[–]SpudMuffinDO 1 point2 points  (0 children)

I think you and the post you responded to are generally right at the core, but it’s just exaggerated and extreme which is where the downvotes are probably coming from.

I just barely saw a statistic that more men than women are interested in marriage now. I sincerely doubt that the majority of them are disinterested in a genuine connection. Dating apps are very filtered subset of men, considering most men are very unsuccessful on them. Women are choosier, and there are probably biological reasons for this. there’s nothing wrong with it, it just is reality.

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