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It is estimated that in 2017 over 80 million people filled a prescription for a psychiatric medication. What does this tell about the people taking these medications (are they all mentally ill?) and how they’re diagnosed (what’s different about the criteria for a diagnosis of depression or anxiety today compared to the 1940’s)?   

In this episode of The Total Self Considered, Jeff Fine interviews Dr Scott Hirsch, a clinical associate professor in the Departments of both Neurology and Psychiatry, as well as Child and Adolescent Psychiatry at NYU Langone. Dr Hirsch shares his insights on our current understanding of mental illness and medications used for treatment, including medical marijuana. As a practitioner who has been exploring the mind-body connection for many years, Jeff is very interested in how Dr Hirsch integrates psychiatry and neurology in his practice. They discuss the distinction between neurologically based disorders and other conditions, how the brain and mind interact, how medications work in treating epilepsy, depression, anxiety and other issues, and the role medical marijuana can play in treating certain disorders and opioid addiction.

https://mytotalself.com/wp-content/uploads/2018/12/Jeff-Fine-podcast-ep-2_mixdown_final_01.mp3

Summary of Episode

• Overlap of neurology and psychiatry
  
• Treating epilepsy and other neurologically based conditions
  
• Serotonin re-uptake inhibitors such as Lexapro, Prozac, Celexa, Paxil, Zoloft  – how do they work?
  
• Serotonin deficiency no longer considered the full explanation of depression
  
• What people think of as depression in 2018 is different compared to 1940s and 1950s
  
• Dr Hirsch reflects on the statistics: in 2017 total amount of psychiatric drugs prescribed in the US was over 80 million prescriptions
  
• Because someone is on a medicine, it doesn’t necessarily mean they have that disorder
  
• How we define “mental illness”
  
• Dysthymia – chronic persistent depressive disorder, used to be called subclinical depression
  
• Medications are tools, and doctors sometimes prescribe because they can make someone’s life better or ease pain
  
• Difficulties of getting off the medication, managing withdrawal. No studies done to guide how long people should stay on medicines, or how to get off of them
  
• Approach to medicating major depressive episodes – minimum effective dose
  
• Patient concerns and stigma attached to psychiatric conditions and taking medication, worries about altering your mind or changing who you are
  
• Medical marijuana – who would benefit clinically from medical marijuana, the certification process
  
• Medical marijuana – different formulations of CBD and THC and what they are used to treat, contraindications
  
• Legalizing marijuana – why it takes a long time for some states to legalize it
  
• One of the best medical uses of marijuana would be in opioid addiction
  

Quotables

“The medicines don’t change who the person is. What they do is they help a person obtain better control of their emotions, their experience, their behavior.” Scott Hirsch

“[Medicine is] Not so much a crutch but something that will help you, like a shoe. You will be able to walk on gravel without hurting your feet.” Scott Hirsch

“Metaphor of diabetes – if your pancreas is not producing enough insulin, you’d probably take insulin to help you. So if your brain needs help modulating your mood…” Jeff Fine

“If [medical marijuana] could help somebody get off opioids, that would be very promising.” Jeff Fine

Resources/links

Jeff Fine’s website: https://mytotalself.com

Jeff Fine’s Total Self blog: https://mytotalself.com/blog/

Dr. Scott E. Hirsch: https://nyulangone.org/doctors/1851514434/scott-e-hirsch

IQVia Total Patient Tracker Database for 2017: https://www.iqvia.com/institute/reports

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