Latest / Flourish- A Prisma Health Podcast / Finding the Right Antidepressant: Dosing, Duration and Risks

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Finding the Right Antidepressant: Dosing, Duration and Risks · Flourish- A Prisma Health Podcast

0:00
Scott Webb (Host): Antidepressant medications are commonly prescribed
0:02
but widely misunderstood by the public.
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And my guest today is back to tell us how antidepressants work, discuss
0:08
the common side effects, and more.
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I'm joined today by Dr.
0:11
Benjamin Griffeth.
0:12
He's a psychiatrist with Prisma Health.
0:21
This is Flourish, the podcast brought to you by Prisma Health.
0:24
I'm Scott Webb.
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Doctor, it's nice to have you back on the podcast.
0:27
Last time, we sort of did some myth-busting about
0:29
mental health, mental illness.
0:31
Today, we're going to talk about antidepressants and how they really
0:33
work because I think some of us think we know, but you would know because
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I know you went to school for like 12 years or something like that.
0:40
So, you definitely know.
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So, what are they?
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How do they work?
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And what types are most commonly prescribed?
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Dr. Benjamin Griffeth:
0:47
So, antidepressants, the idea behind them is for patients who suffer
0:52
from depression and a number of other illnesses, because we use
0:55
antidepressants for a lot of things, and we can come back around to that.
0:59
Host: Sure.
0:59
Dr. Benjamin Griffeth:
0:59
But most patients with mental illnesses where we're prescribing antidepressants,
1:05
the challenge is they usually have a deficiency of neurotransmitters.
1:11
And what neurotransmitters are, are the natural hormones and chemicals
1:16
that one nerve cell uses to talk to the nerve cell next door.
1:21
And if you don't have enough of those, then the signal is not complete.
1:26
And so, that leads to other illnesses like depression, anxiety, things like that.
1:35
And so, what the antidepressants do is they increase the number of
1:40
neurotransmitters available to the nerve cell so that it can talk to its neighbor.
1:46
The way they do that is kind of fun.
1:49
The metaphor I use with most of the patients that I work with and the medical
1:54
students that I teach is a bathtub.
1:57
So if you have a bathtub, and you want it full of a certain amount of water,
2:04
there are two ways to get that certain amount of water full in the bathtub.
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The first is you have to turn on the spigot and have some of that water in, but
2:14
you also have to plug the hole so that the water's not just running right back out.
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Host: Sure.
2:19
Dr. Benjamin Griffeth:
2:19
Almost all the antidepressants work by plugging the hole.
2:25
None of the antidepressants create new or more of these neurotransmitters.
2:31
What they do is they keep the body from breaking down or taking back
2:38
in absorbing the neurotransmitters.
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And so, it's like if you had a bathtub, and you need to
2:46
have the bathtub half full.
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If you don't have the plug in the bottom, it doesn't matter how much
2:51
water's coming through the spigot, it's going to just pour right back down.
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And so, the idea is I'm going to stick a plug in the tub, and that's going
2:59
to allow me to fill the tub where I want it to be so that, in this case,
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I have enough neurotransmitters for my nerve cell to talk to its neighbor.
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There are large numbers of classes of antidepressants out there.
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The most common group right now are the SSRIs, that's selective
3:20
serotonin reuptake inhibitor.
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And I'll break each one of those words down, and I'll kind
3:26
of work from the middle out.
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So, serotonin reuptake, that's the process of taking serotonin, which is one of
3:34
those neurochemicals, and eliminating it from the gap between the two nerve cells.
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And the way that it does that is by reuptake.
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So, my nerve cell who wants to talk to its neighbor doesn't want
3:48
to lose the serotonin, because that serotonin's valuable.
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It spent a lot of time building that serotonin.
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So to some degree, one of the things that it has is it has a
3:59
shop vac that's sitting out in the yard between the two nerve cells.
4:03
And so, when I throw the serotonin flag out there for my neighbor to
4:08
see, since I don't want that flag to disappear, I'm going to use my shop
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vac and I'm going to suck it back up so that I can get it out and use it
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again and again and again and again.
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So if I want that flag, that serotonin flag, to stay out there longer,
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what I have to do is I have to plug up the shop vac so the shop vac
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doesn't suck up that flag again.
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And so, that's the job that it's doing.
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And then, the selective, the very first word, so that's the inhibition,
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is plugging up the shop vac.
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The first word, selective, means originally some of our early
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antidepressants, and those are called tricyclic antidepressants, worked by
4:50
doing serotonin reuptake inhibition.
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But they worked in a lot of other ways.
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And so, the fact is that this group works selectively just on
5:03
the serotonin reuptake shop vac.
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All it does is turn off that one shop vac.
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Now, there are other antidepressant classes that are commonly used.
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The second big group is
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the serotonin-norepinephrine reuptake inhibitors.
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So, the same reuptake process, the same stopping up the shop vac.
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But in this case, we have a red flag for serotonin and a blue
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flag for norepinephrine, which is just another neurotransmitter.
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And so, my job is I now have medicines that stop up both the red
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flag and the blue flag shop vacs so that those flags hang out so my
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next-door neighbor nerve cell can see the signal I'm trying to pass.
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Host: Yeah.
5:51
Yeah, it's really interesting, and I'm trying to follow you along.
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I wish I had some diagrams, but I'm hanging on tight, Doc.
5:58
So then, what mental health conditions can antidepressants really help treat, and
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what kind of benefits can patients expect?
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Dr. Benjamin Griffeth:
6:07
Sure.
6:07
So, I'll take the second piece first.
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So, let's talk about depression, because that's what these
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were originally built for.
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Host: Sure, it's in the name.
6:15
Yeah.
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Dr. Benjamin Griffeth:
6:17
Yeah.
6:18
That's why they're named antidepressants.
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So in depression, a good example is if you choose to start a medication
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for depression, it's most likely going to be one of these groups of
6:30
medicines, the SSRIs or the SNRIs.
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From that, what you should expect to have happen is over time, because we have
6:40
plugged up that shop vac, is the signal across your brain starts to elevate.
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It starts to come back to normal.
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And since that signal is coming back to normal, you should see the reduction of
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the symptoms that go with depression.
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So, you should see things like your sleep becomes regulated.
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You're more likely to sleep at night than in the day.
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That your appetite comes back to normal, your energy improves,
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your ability to enjoy things that are enjoyable comes back.
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Your sense of being able to enjoy the world, not feeling depressed and
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blue and down all the time improves.
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And so, that's the effect that we're looking for with any of these medicines.
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Now, we talked about that in regards to depression.
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These medicines are used in a lot of other illnesses and have been found to
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be effective in a lot of other illnesses.
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So, this works in anxiety.
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We have found that this works for post-traumatic stress disorder.
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We will use these in addition for other mental illnesses, so things like bipolar
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disorder, where we will sometimes add an antidepressant for the treatment of
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the depressed piece of bipolar disorder.
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And so, we use them in a lot of different arenas.
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Again, we first found out that they worked in depression, but then some
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people don't have just depression.
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Some people have depression and anxiety at the time, and one of the things we
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found out was, "Well, let's try this medicine for the depression," and they
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came back and said, "My depression's better, but so is my anxiety."
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And so then, we started taking these to patients who just had anxiety, and they
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said, "Yeah, it works for my anxiety even though I don't have depression."
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And so, that's why to some degree, the term antidepressant is maybe you
8:35
could argue a little misleading because they're actually just good medicines
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for helping stimulate and returning people to normal mental health.
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Host: Yeah, it's so interesting.
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And I've spoken with other Prisma Health experts about GLP-1s.
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And it kind of reminds me of that, that, you know, they create a
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pill for one thing, and then you find out, oh, it helps with all
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these other things as well, right?
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It's just like magic pill.
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And I know that antidepressants are magic per se, but they do seem to help with
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far more than just depression, right?
9:08
Dr. Benjamin Griffeth:
9:08
Correct.
9:08
Yeah.
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And that's the way that medicine has worked since.
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The late 1700s medicine has worked by observing.
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And sometimes what we do is we try something and we say,
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"Oh, that creates this effect.
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Can we recreate that consistently?"
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And that's how you determine that this thing works.
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Host: Right.
9:30
Yeah, wondering, Doctor, and this is anecdotal, but I know that I've
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heard this, especially with one of my kids, teenager when they were
9:37
in high school, and lots of kids were on different types of pills.
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Like, why one antidepressant might work for one person but not another, even
9:45
though they have the same diagnosis?
9:47
Dr. Benjamin Griffeth:
9:47
Yeah.
9:48
So, there are two answers to that.
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So, the first answer to that is even though the diagnosis may be
9:56
the same, the way that diagnosis presents may be very different.
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So, if you think about what's a good example?
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Diabetes would be a good example.
10:07
Some people have diabetes where they lack the ability to produce insulin.
10:14
And so, therefore insulin is a required part of their treatment.
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For other people, they have diabetes because they're insulin resistant.
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Their body produces enough insulin, but their body doesn't respond to the
10:26
insulin the way that they used to.
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And so, sometimes insulin's the answer, but often other medicines are the answer.
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And so, even though the diagnosis may be the same, it may be
10:37
different in different people.
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And so, that expression sometimes will change the medications we use
10:44
or how you respond to the medication.
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So, taking depression that we've already started talking about as an example.
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Some of my patients with depression notice that they have a lot
10:54
of trouble sleeping at night.
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They have a lot of trouble with loss of appetite, not eating a whole bunch.
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But I have other patients with depression who because of their depression, would
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prefer to sleep 22-1/2 hours a day.
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And when they're not asleep, they're eating everything
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they can lay their hands on.
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And so even though the diagnosis is the same, it expresses it differently.
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And so, sometimes that helps us choose which medicines to use based on the
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symptoms of illness that they have.
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And so, that goes back towards the first half of why does this antidepressant work
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for this person and not for the other, is sometimes that variance of expression
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changes what antidepressant we would use.
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The other piece is everybody is biologically, genetically,
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psychologically, and socially unique.
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And I have difficulty being able to predict because our
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science has not gotten that far.
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I have difficulty predicting which medication directly off the first time I
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see you is most likely to work for you.
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But the interesting thing is, just like illnesses tend to run in family,
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for instance, in our last podcast, we talked about arthritis in your family.
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Also, mental illnesses tend to run in families, and response to
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medicine tends to run in families.
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So if you have a mother, a father, an aunt, uncle, cousin who has the
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same illness as you, who improved with a specific medicine, as the
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prescribing doctor, I'm more likely to start there because if the illness
12:32
is the same, that means that maybe you all share the genetics for that
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illness, and you all may share the genetics for the response to medicine.
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And so, that's how that decision sometimes gets made.
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Host: For sure.
12:45
Doctor, let's go through the process, you know, working with a doctor like
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yourself to determine whether an antidepressant is appropriate for us.
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And as you're saying, like, oftentimes you're sort of trying to predict, "Well,
12:56
I think maybe this one will work."
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But as we go through this process and try to find the right medication
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and dosage and all of that, take us through that process.
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Dr. Benjamin Griffeth:
13:05
Yeah.
13:05
So, we kind of opened the door to that with the previous question.
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So, I'm often going to marry my medication with the symptoms
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that the patient presents.
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So, some of my antidepressants tend to create energy, kind of drive people to
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feel a little better, sleep a little less, maybe even suppress appetite a little bit.
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And so if I have a patient who's sleeping 23-1/2 hours a day and eating
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everything in sight, I'm going to choose that medicine for them because
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the effects of my medicine directly look at the effects of their illness.
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But that illness, if I gave that to the person who's already having challenges
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eating, already having challenges with not sleeping, if I energize
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them and decrease their appetite, I'm actually going to make them worse
14:00
or transiently worse, not better.
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And so, that's the first thing I'm doing, is I'm doing a good thorough
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history, trying to understand not only, "Hey, check the boxes, tell me
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which symptoms you have," but also how do these symptoms impact you?
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How does your life work right now?
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And figuring out which medications, because of their effect, best fit the
14:23
symptoms of the illness that you have just like I don't have the ability to
14:29
unravel your genetic code and figure out exactly which medicine may be right for
14:33
you, that's the same issue with dosage.
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Some people need lower doses, some people need higher doses.
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As a conservative physician, which almost all physicians are, we want
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the least amount of medicine that's going to make the impact that we want.
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And so, we always start at the lowest doses and give you the opportunity
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to see is the low dose going to work?
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ause no reason for you to be taking more medicine than your body needs to improve.
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And so we start at the low doses and recognize that a large number
15:09
of people will respond to low doses, but some people may need more.
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And so, when we see you in follow-up, that's what we're checking.
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How has the medicine made a change?
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How much change have we seen?
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Do we need more change from the medicine, or do we perceive that
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we're on the right trajectory, right?
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If, you know, I see you and I start a medicine.
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And two weeks later, three weeks later, I see you back for follow-up and you're
15:35
50% improved, well, I don't need to do anything because by the four to six weeks,
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which is where we are going to see the maximum effect of that antidepressant,
15:45
well, if you went and half the time you're half better, by the time we get
15:49
to full time, you should be fully better.
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And so, I don't have to.
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But if you come back at that three-week, four-week appointment and you're only
15:58
20% improved, aha, we need to change the dose towards trying to get you to
16:03
remission, getting you to the place where you're not having symptoms
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Host: Right.
16:08
Yeah, I'm sure, a part of this anyway, this is just an inference of course, but
16:11
I'm sure that sort of talking to patients and getting a sense of any side effects
16:16
is beneficial as well as a part of this.
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So, like, maybe what are some of the most common side effects, the risks
16:22
of antidepressants, maybe concerns about serotonin syndrome and so on?
16:26
Dr. Benjamin Griffeth:
16:26
Yeah.
16:27
So, there are a wide variety of side effects potential to antidepressants,
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and they vary class to class.
16:37
But in general, almost all antidepressants, there are one or two
16:42
that this doesn't apply to, but nearly all work on the serotonin molecule,
16:47
the serotonin neurotransmitter that we discussed at the very beginning—serotonin
16:53
and when we start to modify how much serotonin is in your system.
16:58
Recognize serotonin doesn't just exist in the brain.
17:01
It also exists in the nerve cells of your stomach, for instance.
17:06
And so, it's well known that starting an antidepressant, about 20% to
17:12
25% of patients when they first start out may have some GI upset.
17:17
One of my patients described it probably the best I have ever heard.
17:20
It's not like nausea and vomiting, but he described it, it's like if you drank
17:24
a couple of cups of coffee too fast, that kind of just jittery butterfly
17:29
feeling, because serotonin's impacting the nerve cells in your stomach.
17:33
And so, that's where that comes from.
17:36
And sometimes some people, that GI upset will even follow farther down
17:41
the gut, leading to maybe some mild diarrhea within the first couple
17:45
of days of starting the medicine.
17:46
But in general, reasonably well-tolerated.
17:49
It happens to a minority of patients who start the medicine, and it's time-limited.
17:54
It goes away within two or three days.
17:57
Likewise, headache tends to be very, very common with starting any
18:01
medicine having to do with serotonin.
18:04
That mechanism is much less understood as to where the headache is coming from.
18:10
The good news is, is for a vast majority of patients, Tylenol,
18:14
Motrin, whatever they would normally take if they had a headache anyway,
18:17
tends to work for this headache.
18:19
And again, it's time-limited, tends to go away.
18:23
Less common side effects, but one that I talk about very, very
18:26
frequently is sexual side effects.
18:30
The SSRIs are known to cause sexual side effects.
18:33
Now, the good news is, it happens in only about 10% of patients, so a vast majority
18:38
of patients don't have the challenge.
18:40
But for those that have this side effect, what it leads to is delay in orgasm or no
18:47
orgasm at all, for males and for females.
18:50
And unfortunately, sex is important to pretty much all adults.
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And so, I usually tell most of my patients about that side effect so they're aware.
19:01
They know that, "Hey, the problem in your sex life is coming from something
19:05
that I did, and it's something that I can correct if you're one of that unfortunate
19:09
minority that have that side effect."
19:12
And that sexual side effect, for whatever reason, tends to stick, as opposed to
19:16
the headache, the upset stomach that tend to go away in a couple, three days.
19:20
That sexual side effect tends to hang out as long as you're on that medicine.
19:25
But I can solve that by switching to other medicines.
19:28
And again, one of the things we haven't talked about, because this
19:30
one is focused on antidepressants specifically, but sometimes you then
19:34
also can have the discussion about, do we need medication, or can we
19:38
start talking about psychotherapy, or other treatment processes other than
19:43
medication that may be just as effective for the treatment of your illness?
19:47
You asked about serotonin syndrome.
19:49
Serotonin syndrome is a very rare event.
19:52
So, let's go back to that bathtub metaphor that we used at the very beginning.
19:56
So, I've taken my SSRI, and I've stuck it into the plug.
20:03
And so, now my bathtub is not draining.
20:06
Well, as anybody who has had kids or been a kid knows, if you plug
20:11
the plug and you turn the faucet on, eventually you may overflow the tub.
20:16
Host: Of course.
20:17
Dr. Benjamin Griffeth:
20:17
My description for what serotonin syndrome is.
20:20
Serotonin syndrome is very, very rare by just plugging up the tub.
20:26
It usually has to have a combination of plugging the
20:28
tub and turning the faucet on.
20:31
And so, sometimes that is plugging the tub and your diet accidentally happens to
20:38
be exceptionally rich in the amino acids that you take in that create serotonin.
20:45
I have never seen that happen in 25 years of practice of
20:48
psychiatry, but it does exist.
20:50
There are certainly journal articles and paper reports of
20:54
those very, very rare instances.
20:56
It's substantially more likely when I've taken a medicine like an SSRI
21:02
and I have plugged the tub, and then not knowingly, I've taken another
21:07
medicine that opens the spigot, that increases serotonin expression.
21:13
A good example of this is, and one of the things that we tend
21:16
to warn patients about, if you take medications for migraines.
21:22
Migraine medicines, most of them work by increasing serotonin temporarily.
21:28
And so, sometimes patients who are prone, who take an SSRI for their
21:35
depression, and then they take their anti-migraine medicine, they
21:40
put themselves at potential risk.
21:41
And so, most of us who prescribe SSRIs ask, "Hey, do you take
21:45
anything for migraines?"
21:46
Most of the doctors who prescribe for migraines say,
21:49
"Hey, are you taking an SSRI?"
21:51
Because that combination has the potential to create serotonin syndrome.
21:56
Serotonin syndrome is very uncomfortable.
21:59
You have a bit of a fever, your heart rate goes up.
22:03
You're going to feel sweaty and clammy, and you just feel kind of terrible,
22:08
a lot like if you had the flu.
22:10
It can get worse, where you actually need pretty aggressive medical care.
22:15
So if you happen to be somebody taking an SSRI, and then you take something and
22:19
you start feeling really, really cruddy, You need to call your doctor or need to
22:23
consider going to urgent care or even the emergency room just to make sure
22:27
that if you happen to be having serotonin syndrome, you can be monitored because
22:33
it can be dangerous if it becomes severe.
22:36
That said, that's a fairly uncommon process to have serotonin syndrome
22:40
to begin with, and also very, very uncommon if even if you have it, that it
22:45
becomes severe enough that it requires monitoring, hospitalization, and so forth.
22:49
Host: Yeah.
22:51
Our last podcast, Doctor, was the myth buster, the myth-busting podcast.
22:55
But I have a myth for you here that, once you start an
22:57
antidepressant, you're on it forever
23:01
Dr. Benjamin Griffeth:
23:01
Not true.
23:02
What you have to do is to have a good discussion with your prescribing
23:05
doctor about expectations.
23:08
So, let's talk about antidepressants and depression, because the
23:13
rules change when you change the illness that you're treating.
23:17
But let's take depression because it's the most common
23:20
that we use antidepressants for.
23:22
If you were to come into my office and you were having depression for
23:25
the first time and we choose to use medicine for your treatment.
23:30
And so, I start the medicine, you get better.
23:34
What I tell every patient is where the data is, is you need to, from
23:40
the time that you feel well, we put a pin in the calendar and we go at
23:45
least six months, preferably a year.
23:48
Because anybody who comes off the antidepressant earlier than that
23:53
have a fairly high likelihood of returning to depression.
23:57
But if I get you well, I get you to remission, and I keep you at remission
24:01
for six months, preferably a year, then we take you back off the medicine.
24:06
And the good news is you have a 50/50 shot of never having depression again
24:12
in your life, which is outstanding.
24:15
Host: Right?
24:16
Dr. Benjamin Griffeth:
24:16
Now, let's assume that you're one of the unfortunate half that
24:20
has it come back a second time.
24:23
Well, when you have the second time, then we're going to say
24:26
you need to be on the medicine.
24:27
And once we get you to remission where you're having no symptoms, we
24:31
need to put the pin in the calendar, and we need to go two years.
24:35
Because the increased length of time improves the chance
24:40
that you don't have recurrence.
24:42
Now, the problem is with the second time, the chance that you never
24:47
have depression again lowers.
24:48
Only about a quarter of the people who have had two episodes of
24:52
depression never have it again.
24:55
That's the unfortunate number.
24:56
So if you've had it twice, there's a reasonable likelihood that
25:00
you're going to have it again.
25:02
And so when the patient comes to me with their third episode of depression,
25:07
typically then I'm talking lifelong treatment because the side effects
25:12
of the medicine are minimal, right?
25:15
We talked about the transient headache.
25:16
We talked about the transient stomach upset.
25:19
We talked about the low chance of sexual side effects from these medicines.
25:24
And if you look at that very, very mild risk versus being depressed, not able to
25:30
concentrate, no energy, poor appetite, low concentration, and depression's
25:36
impact on physical function, psychological function within their heads, social
25:42
function within their lives, impact on work, impact on families, that impact is
25:48
so much bigger than that very, very low risk of challenge from the antidepressant.
25:55
And so, typically, after the third episode of depression, we start
25:59
talking about lifelong treatment.
26:00
Host: Yeah.
26:02
Yeah, this has been really interesting.
26:04
It's been great to have you on both times.
26:06
Hopefully, we'll talk again in the future.
26:07
Let's just finish up today, Doctor.
26:09
We're having this conversation with someone like yourself
26:11
about antidepressants and which one is right for us.
26:14
What types of maybe foods, drinks?
26:17
You mentioned with serotonin syndrome, the migraine pill's
26:20
interaction with antidepressants.
26:22
But just generally, what would we need to know about our sort of
26:25
behavior, lifestyle, eating, drinking habits that we would have to avoid?
26:29
Dr. Benjamin Griffeth:
26:29
Outstanding.
26:30
So, that can be very, very specific to the medicine or class of medicine.
26:36
So, the first answer to that is when you're starting any medicine, whether
26:41
it's an antidepressant, whether it's a diabetes medicine, whether it's a
26:44
cholesterol medicine, which I happen to be on, having that discussion with your
26:49
doctor about, "Okay, what should I be doing about food, drink, other medicines?"
26:54
should be an automatic conversation that you and your doctor have
26:58
with any medicine, period.
27:00
Now, getting very, very broad with antidepressants as a group, I
27:05
will tell you that there's no real impact from food and the medication.
27:12
What I can tell you, though, if you look at depression, anxiety, bipolar
27:16
illness, other post-traumatic stress disorder, those places where we
27:20
use antidepressants, food's impact on the illness is significant.
27:26
And so, there, talking with your doctor about, "Hey, plant-forward,
27:30
whole foods-based, making sure that you have a well-balanced diet that has
27:35
lots of dark leafy green vegetables, fresh fruits, those kinds of things
27:39
all make a significant positive impact on the illness irrespective of
27:45
what medication you may be taking."
27:47
So, no food impacts antidepressants, and all foods have the ability to improve the
27:54
illness independent of the medication.
27:57
Now, I'll put a minor caveat in the food because there is a one group
28:03
of antidepressants, I'm not going to go into any specifics, but they
28:07
do have specific food problems.
28:11
But any physician who's going to be prescribing those is going to go at great
28:15
lengths over many, many days to make sure you understand the diet that has
28:19
to be adhered to for those medicines.
28:22
And those are very rarely used medications, and so probably don't need to
28:27
be discussed for the general public who's going to be listening to this podcast.
28:31
Host: Right.
28:32
Right.
28:32
We're covering broad strokes here, for sure.
28:34
Dr. Benjamin Griffeth:
28:34
Very broad strokes.
28:35
When we talk about drinks, the only thing that you have to be aware of is alcohol.
28:40
And alcohol with antidepressants, it's not because alcohol impacts
28:46
the antidepressant, it's that the alcohol impacts the illness.
28:50
So, taking depression, alcohol, if it's consumed more than one or two drinks
28:56
a week, alcohol acts as a depressant.
28:59
It makes depression worse.
29:02
And unfortunately, alcohol's a more powerful depressant than
29:06
any of my antidepressants.
29:08
And so for most of my patients who have depression, even people who
29:12
don't have, an alcohol use issue, but they just have moderate drinking, "I
29:16
have, you know, a glass of red wine every night with dinner for my heart
29:20
disease or for my cholesterol," which there are a number of people who do.
29:23
So, you can take alcohol without having an alcohol use issue, I'm still going
29:28
to recommend limiting your alcohol to only one or two drinks a week because
29:35
the depressant effect of alcohol is going to overpower the antidepressant.
29:40
Host: Right.
29:41
Yeah, almost sort of defeat the purpose, right?
29:43
Dr. Benjamin Griffeth:
29:43
Exactly right.
29:44
Yeah.
29:44
So, it's not that there's an interaction, it's just that, "Hey, doing one with
29:48
the other doesn't make any sense."
29:51
Medications that you should avoid, they're really very, very few.
29:55
Though I brought up migraine medicines and SSRIs, that's a
30:00
really uncommon situation to see serotonin syndrome as an interaction.
30:05
So for those who are listening who happen to be taking an SSRI and
30:08
happen to have migraines, yeah, have a discussion with your doctor
30:11
about, "Hey, what should I watch?
30:13
What should I be aware of?"
30:14
But that's a very rare thing.
30:16
Some of our antidepressants do affect blood pressure.
30:21
And so, I tend to tell folks, "If you have blood pressure problems or
30:25
you are taking one of the ones that affect blood pressure," they happen
30:29
to be that serotonin-norepinephrine reuptake inhibitor group, then,
30:34
hey, when you go to get your over-the-counter cold remedies, you
30:40
need to be looking for the ones that have the blood pressure indication.
30:44
Because the SNRI with a traditional cold remedy, your blood
30:51
pressure may increase a little.
30:53
And we're not talking, you know, through-the-roof increase, but it
30:57
can be somewhat of an increase.
30:59
And any increase in your blood pressure over time is not good for you
31:03
Host: Right.
31:03
Yeah, absolutely.
31:05
Well, listen, it's been great to have you on, great to have
31:07
your time, your expertise.
31:08
You're so compassionate and knowledgeable and full of, you
31:12
know, metaphors and analogies.
31:14
I just loved it all.
31:15
Thank you so much.
31:17
Dr. Benjamin Griffeth:
31:17
My pleasure, Scott
31:18
Host: For more information and other podcasts just like this one, head
31:21
on over to prismahealth.org/podcast.
31:24
This has been Flourish, a podcast brought to you by Prisma Health.
31:27
I'm Scott Webb.
31:28
Stay well.