Quick list Side effects and safety

“the best advice is to avoid weight gain inducing medications. Avoid weight gain inducing medications. Prevention is the best strategy there. Now, don't get me wrong. Some people also begin to gain weight, even on the medication that treats depression that does not itself cause weight gain”

“Why do some people get worse than antidepressants? In my opinion, it's mostly because they have some kind of a more bipolar disorder type condition and experience antidepressant-related agitation and sleep problems. That's probably, in my opinion, why we see the increased risk for suicidal ideation in people under the age of 25 on antidepressants”

“rem deprivation can treat depression which is very bizarre to me yeah if you just wake people up before they hit rem which if you do that to an average person they'll hate you and be miserable um it can help treat depression”

“we don't use Metformin enough with these medications. Now I'm thinking we don't use GLP-1s enough with these medications”

“for the telehealth people out there you can at least ask the patient to weigh themselves on a regular basis and self-report don't forget to weigh your patients now if you want to be really gold standard you're going to do waist circumference”

“I think that a degree of weight gain that we see on these medications is not fully from the medication effect itself, but is actually from the treatment effect. People, many people, don't eat when they're in emotional distress”

“checker prolactin levels, It's super low threshold to check our prolactin level on these patients”

“Largely, in my experience, outpatient akathisia is subjective. It's something that the patient feels. They can suppress it, especially in the encounter with you”

“You can get abrupt withdrawal dyskinesias that can go away or they can persist. A little scary. and it's definitely more likely to happen in people with mood disorders and have schizophrenia so please use your antipsychotics sparingly and only as needed for the clinical picture”

“schizophrenia has its own rate of movement disorders, okay, without antipsychotic use. If you look at pre-antipsychotic studies, they were already developing tardive dyskinesia anyway”

“some of the antipsychotics can actually worsen OCD. I think clozapine and olanzapine are the most likely”

“a lot of antipsychotics are depressogenic. They can lead patients to depression and long-term aren't great. A lot of these medications come with really bad side effects, really bad metabolic effects. There's risks of... of EPS, tardive dyskinesia, typically not the lower doses”

“We've all seen patients gain a ton of weight on aripiprazole. I do think women are affected significantly worse than men. Most of the patients that I've seen gain a ton of weight tend to be women”

“It can actually lower antipsychotic induced prolactin because even though it's a partial agonist, it binds first before the other antipsychotics”

“beyond that, it doesn't have the sexual side effects. And it has very few side effects long term, I think, compared to any of the other medications”

“For sexual side effects, main ones, buspar and bupropion. Those are going to be most helpful. and otherwise switching of the medication or lowering the dose are pretty much your choices”

“Yes, it can cause Stevens-Johnson syndrome. Yes, it is a teratogen. So using it in reproductive age women is a whole different ballgame. So we should start thinking of it a little bit more like valproid”

“There are ethnic groups that will have a higher risk of SJS, Steven Johnson syndrome, to lamotrigine, oxcarbazepine, carbamazepine, those kinds of things. Okay. And there is testing available to see if they have the gene that puts them at particularly high risk”

“After that, Latuda, Geodon are probably the best ones to go to in terms of not having much weight gain. and second generation. Vraylar, relatively new. I have not seen much weight gain on that either”

“because chlorpromazine does hit the ham receptors. So it does have histaminergic alpha-1 and muscarinic problems. The reason why we call it first-gen is because it does also cause EPS. It does cause high risk of tardive dyskinesia”

“I don't think I've ever kept anyone on chlorpromazine as outpatient, to be honest with you. And I don't think any of my patients have ever kept themselves on chlorpromazine as outpatient either. It's just so poorly tolerated”

“Strong anticholinergic effects, QTC prolongation, very sedating. weight gain. So not necessarily the greatest choice, but if it's viable, you can consider it”

“clozapine and olanzapine are probably the two worst drugs we have in regards to metabolic risk in terms of weight gain. It's more significant in non-white patients. It's very reasonable to start metformin from day one”

“Don't titrate the metformin too fast. So it does cause a lot of DGI distress. So start low. Typically the dose is the same as if they had diabetes”

“when you're at the point that you're using clozapine, you're a little bit less worried about those other risks because of the benefit and necessity that clozapine kind of offers”

“The orthostatic hypotension is due to the alpha-1 blockade. Super common, 20% incidence. And that's why we have to titrate slowly because you don't want to zonk the patient”

“You encourage hydration. You increase sodium intake if it's possible. If it's possible, you should avoid other alpha-1 blockers, avoid benzos”

“it's believed that the metabolite nor clozapine has muscarinic agonist properties. And that's possibly what leads to the clozapine drooling”

“Do not use glycopyrrolate first line. So you do not want to increase the muscarinic burden of these patients. So glycopyrrolate, which is a systemic anti-muscarinic medication”

“some of the antipsychotics can actually worsen OCD. I think clozapine and olanzapine are the most likely”

“We have to understand that we're starting to get into the territory of just broad suppression of neurons and that there could be habituation. I've never seen it with my patients on gabapentin”

“You ask yourself, Do I want to be sleepy, fat, and full of metabolic syndrome? Or do I want to be developing more targeted dyskinesia and having more akathisia”

“any major dopamine blockade medication can at least cause neurolepsis, you know, some apathy, emotional blunting and low motivation”

“there's at least one study showing relative safety in pregnancy. So that's a nice thing to have with trazodone. While we're on it, I believe other ones that are generally accepted in pregnancy that you can see here on the board include Haldol, Olanzapine, and Quetiapine”

“I think it's overly sedating for most people during the daytime. So I almost exclusively use it for nighttime dosing, but it's not the first one I reached for”

“They have no side effects or long-term risks. This is like almost nothing. Lamotrigine gets close, but otherwise it's almost nothing”

“We're talking about a rash that is new and that you haven't had before and that's different. If you get any new rash while we're starting this medication, I want you to stop the medication and go to the ER. That's how I do it”

“don't be like, you know, the rash isn't that big a deal. Like, why don't you, like, you have to still give the proper responses, even if the system behind you is not built to appropriately respond to it”

“I think of it very much in the way that we talked about low-dose lithium in terms of how to manage it. Don't let people have side effects. That'll blow the ballgame”

“What are the two major adverse effects in my experience with lithium? It is thirst combined with increased urination. Not the same as diabetes insipidus. That can happen. It's more rare. And then acne”

“if you're dosing it appropriately and at the minimum effective, then you're not going to see much weight gain. But acne, unfortunately, if it happens, there's not really much you can do about it”

“the 20-year actual risk for renal dysfunction when you're not using it at the manic doses is much, much tinier than everyone is aware of”

“So make sure you talk to your patient about hydration, right? Salt intake because taking in too much salt will lower the lithium level and not taking in enough salt will raise the lithium level. Being dehydrated will raise the lithium level and over hydrating will wash out the lithium”

“when it comes to the blood pressure medications, the ones that interfere with lithium, there's actually quite a few. And what I just say is you need to make sure you tell your primary care doctor or whoever prescribes you a blood pressure medication that you're on lithium”

“high levels of lithium guarantee you decline of kidney function. High levels of Depakote do not guarantee any end-organ dysfunction necessarily. You've got to monitor for it, but it's not a guarantee. You're pretty much looking out for a low platelet issue. Hyperammonemia, the liver producing too much ammonia”

“spironolactone, which we know increases lithium levels. So it is an option if you have a very compliant patient that you can check labs, check labs before the dose, the start of the spironolactone, check labs after the start of the spironolactone dose”

“But that said, it's not 1000% contraindicated. And if the patient fully understands the risks, they're well monitored, they've got good family support, you've got a close eye on them, it's not completely contraindicated”

“there is amiloride. Technically, that has been written about and has some small case studies about where you add that with lithium and it reduces the amount of damage that lithium can do to the kidneys and also reduces the polyuria”

“The medications I do favor that cause less weight gain do tend to be pretty bad for akathisia, and that is Latuda and Abilify. Latuda is definitely number one and Abilify is up there in terms of akathisia risk”

“It is metabolically pretty clean. I have had patients who have been on it and have had minimal weight gain. Minimal QTC prolongation, low prolactin”

“But I do see it does have less of that cognitive dulling that I see with a lot of the other antipsychotics”

“there's at least one study showing relative safety in pregnancy. So that's a nice thing to have with trazodone. While we're on it, I believe other ones that are generally accepted in pregnancy that you can see here on the board include Haldol, Olanzapine, and Quetiapine”

“MAOIs, the problem is that you have a risk for a hypertensive crisis with certain foods. Dr. Malzberg, it is tyramine. Tyramine. And in a way, all the best foods have this to some extent at a wine party”

“I say expect a hangover. What I usually see is three to four days of feeling like a little bit of a zombie. I do not recommend starting this medication the night before you have a big work meeting”

“I find that even at low doses, there's considerable appetite increase in weight gain for both of those medications. So I avoid them”

“they have much more side effects. They are dangerous in high doses in QTC prolongation. They make people have anticholinergic side effects like dry mouth, urinary retention, and they're very sedating”

“clozapine and olanzapine are probably the two worst drugs we have in regards to metabolic risk in terms of weight gain. It's more significant in non-white patients. It's very reasonable to start metformin from day one”

“some of the antipsychotics can actually worsen OCD. I think clozapine and olanzapine are the most likely”

“there's at least one study showing relative safety in pregnancy. So that's a nice thing to have with trazodone. While we're on it, I believe other ones that are generally accepted in pregnancy that you can see here on the board include Haldol, Olanzapine, and Quetiapine”

“SJS, same SJS risk. You can't tell if it's higher or not because they don't use oxcarbazepine as much as lamotrigine. Lamotrigine is used so much more that is then associated with a lot of SJS cases”

“One of these days, you're going to have somebody get dizzy and nauseous. And it'll be because they have developed type 1 atremia, low blood sodium”

“the prolactin with Invega or paliperidone and risperidone, you really want it. They're the ones that are most likely by far to cause a prolactin elevation”

“I don't like the anticholinergic effects. I don't like, um, there's weight gain. Uh, it's not good. It's got the worst, I think it's the worst SSRI for pregnancy”

“So you get less of the EPS and the akathisia of haloperidol or the fluphenazine, which are the high-potency first-gen antipsychotics. Metabolic, be a little bit cleaner. Minimal weight gain, but still, you do get the moderate EPS risk. Actually, surprisingly decent at negative symptoms”

“Lyrica is too effective. The absorption, speed, and amount is sufficient to make this a possibly habit-forming drug. And, of course, that also means that the risk of withdrawal effects are higher”

“Don't use it in asthma. Do use it But for people. People who have comorbid migraine disorder. It can help a little bit with, yeah, consider it and be careful of the cardiac effects, of course”

“beta blockers historically were viewed as depressogenic. So to me, it doesn't, I think there was a study that showed that propranolol didn't hit that, but I still think of most beta blockers Use long term as the. Depressogenic”

“You can use it in PTSD, anxiety, depression, all that stuff, but massive weight gain, appetite increase, diabetes risk, and sedation in comparison to the actual antipsychotic benefits you're getting”

“I find that even at low doses, there's considerable appetite increase in weight gain for both of those medications. So I avoid them”

“It seems like giving antipsychotics to people without schizophrenia raises the risk of tardive dyskinesia”

“it's for the second gen antipsychotic, the most prolactin elevating and also the most likely to cause EPS, especially when you're hitting the four milligrams and above”

“Risperdal obviously causes prolactin problems. Don't be so gung-ho giving it to your female patients. You can get away with giving a low-dose Abilify to bring that down”

“Because the patch is absorbed systemically and not through the gut, there's a much lower risk of the tyramine reaction. That's right. Theoretically, and I think it's still recommended to follow the diet, but theoretically, there's less risk of the hypertensive reaction from tyramine-contained foods”

“you're not supposed to give sleep medications to untreated sleep apnea. It's not good, right? You're just going to be suppressing their respiratory drive that they need”

“most adverse effects in most people that have unipolar depression only, it's just nausea and diarrhea. You're going to get a little bit of that stomach cramping. It's going to last three to five days and get better and come back briefly with each dose increase until it gets better again”

“I try and bring up emotional blunting. I hear a lot of patients, especially if you get into the, I think the more borderline or the more severe end of it, that because they're so prone to feeling things so intensely, they're very prone to reporting the emotional blunting”

“For sexual side effects, main ones, buspar and bupropion. Those are going to be most helpful. and otherwise switching of the medication or lowering the dose are pretty much your choices”

“Now, the bruxism, tooth grinding. You know, Honestly, probably the safest thing would be a mouth guard, which would be quite annoying, but it would protect your teeth. You could consider maybe using a sleeper of some kind”

“SSRIs have not been shown to specifically reduce suicidality. Though, of course, they have far less side effects and are much safer than older antidepressants”

“You should be advising patients about risk of suicidal ideation and agitation from SSRIs. Again, this is really primarily probably in bipolarity, but it is a risk”

“Don't forget also random herbs and supplements. A lot of these are unregulated and have some stimulant properties. And then finally, steroids, prednisone, or any other more esoteric or unique medications, prescription medications that can cause mania”

“I just ask patients to use ones that have been Approved by like that pharmaceutical testing board at least. So that's basically nature made or like Costco brand is usually the easiest to find”

“Trazodone has an active metabolite. Called MCPP. Okay. Metachlorophenylpipirazine, which is apparently like a designer drug that causes agitation and dysphoria, but also may have antidepressant effects”

“I do get wary and careful if we're going to TRASM above 150 in bipolar disorder or if we're doing mirtazapine above 15 or 20-ish”

“they have much more side effects. They are dangerous in high doses in QTC prolongation. They make people have anticholinergic side effects like dry mouth, urinary retention, and they're very sedating”

“The valproate, the The teratogenicity makes it so that women absolutely should not be using it, period. And if you have a woman who's on the medication, you pretty much have to taper it off if they're talking about pregnancy planning”

“Why would you start a patient on a medication that in the next five years, next 10 years, you know that you're going to have to taper them off”

“There's a study showing that Depakote works better in mania if given with folic acid. And we know that Depakote tends to deplete folate, so it makes sense to give it”

“venlafaxine has a very severe withdrawal syndrome and paroxetine has plenty of weight gain, some anticholinergic, Even if it has to benefit”

“she decided to abruptly stop taking her Effexor a few days before. And the withdrawal syndrome was so bad it resembled a medical illness to her and to her caretakers and even caused a little delirium”

“I have seen that Vilazodone and Vortioxetine are the two meds that are marketed as slightly lower sexual side effects”

“I have seen that Vilazodone and Vortioxetine are the two meds that are marketed as slightly lower sexual side effects”

“There are diminishing returns. You need to differentiate between the energy boost in euphoria and the clinical treatment of ADHD”

“there's a sense that the stimulant stops working in some sense or needs a higher dose after initially working for a few weeks, that's not the medication treatment effect. That's the drug effect. So do not fall for that trap”

“it doesn't treat depression in the long term. And what I've seen with so many patients who have ADHD plus depression is you're You're not treating the depression and you'll see irritability creep up. You'll see somatic symptoms creep up”

“once they're starting to turn 18 or in their 20s, they start developing stimulant-induced psychosis. Okay. And how do I know it's that? Because I pull them off the stimulants and the psychotic symptoms stop”

“we know that amphetamines are just a little bit more rewarding, have higher abuse potential. And a lot of those conditions that you that you were naming that, you know, people are They know they have a problem and they cling to ADHD”

“if you're treating a proper ADHD, the psychological anxiety reduction far outweighs It's the minor physiological. Physiological anxiety”

“I'm going to avoid them like the plague unless I can't get away without using them. So the first thing I'm going to say is that if someone is on a antidepressant and they're rock solid stable, then fine”

“The big problem is inducing mood instability and mixed states. You make cycling more likely to happen because antidepressants are Antidepressant, all antidepressants with almost no exceptions are pro cycling”

“it's not a never use them. It's a use them after you've tried multiple other things. And there's a specific subset of patients for whom I think there is a potential role. And when I finally come around to that, it would be bupropion”

“when you persist with SSRI in someone with bipolarity, that's where it becomes more harmful and dangerous. And there are other treatment options”

“Somebody with a bipolar disorder generally can become agitated or worsen if you give SRI, serotonin reuptake inhibitor, So do be careful about that”

“the people who might have a little bipolarity, even if they'll never have a real bipolar disorder or have very high levels of anxiety, then yeah, going too quickly on the medication like Lexapro can definitely, uh, cause some reactions there”

“pulling it off quickly is also an acute stressor. So you need to be mindful of that”

“I'm of the camp that anyone with a manic depressive illness bipolar disorder, regardless of their comorbidities, should not be treated with an SRI whenever possible”

“I wouldn't give peroxidine. A lot of people like to use Paxil kind of for sleep, but this is an SSRI. This is a potent SSRI with a lot of withdrawal effects”

“I do get wary and careful if we're going to TRASM above 150 in bipolar disorder or if we're doing mirtazapine above 15 or 20-ish”

“methylphenidate, which there's at least some preliminary evidence showing is more suitable for use in bipolar disorders, though personally, I never give stimulants to bipolar disorder patients”

“for some people, they do simply have at their baseline, even without a particular stress in their life, just thoughts about not wanting to be alive, wanting to hurt or kill themselves. most of the time”

“sometimes the indicated treatment may not be hospital admission. Sometimes hospital admission can potentially slow down the overall progress towards getting better”

“patients with borderline personality disorder are at an elevated risk compared to patients without borderline personality disorder of completing suicide”

“It is a risk factor. It's just not as serious of a risk factor as perhaps severe, agitated psychosis with command auditory hallucinations to make suicide, right”

“If you have intense counter transferential feelings of any type, that's a sign of self and interpersonal functioning. And that can, especially under distress, be quite dangerous”

“The big problem is inducing mood instability and mixed states. You make cycling more likely to happen because antidepressants are Antidepressant, all antidepressants with almost no exceptions are pro cycling”

“some of the antipsychotics can actually worsen OCD. I think clozapine and olanzapine are the most likely”

“I'm of the camp that anyone with a manic depressive illness bipolar disorder, regardless of their comorbidities, should not be treated with an SRI whenever possible”

“do not be afraid also to use mood stabilizers. We don't understand these categories as much as we think. And I think the reality is that there's probably a lot of genetic and pathophysiological crossover between the bipolar disorders and the schizophrenia and sometimes OCD, ADHD, autism”

“just because you're more likely to be a victim doesn't mean that you're also not more likely to be a perpetrator, too. Right? That doesn't make any sense”

“when a parent kills their own child, if you look at the studies, pretty much a majority of them did have psychosis. But what are some other reasons why someone might kill their own children”

“the moderate grade severity psychosis often goes unnoticed. but it can impact people's decision-making, thinking, and beliefs about the world”

“a large chunk of people basically got moved from what were the insane asylums and state hospitals of the past to jail and prison of today. This has had an effect on, in my opinion, psychiatrists, the majority of psychiatrists, their ability to detect and understand psychotic disorders”

“in the emergency room, the definition of getting inpatient hospitalization involuntarily is acute danger to themselves or others”

“If you encounter it because of a delusion, right? A hallucination. It's technically not objectively threatening. But I would say that that's a situation where most people encountering that and unable to tell it apart from reality would be objectively threatened”

“you're not supposed to give sleep medications to untreated sleep apnea. It's not good, right? You're just going to be suppressing their respiratory drive that they need”

“What makes people dangerous from a mental health standpoint? The number one thing is drug use. And I don't care if he's not interested in rehab. Do I really know that he's had enough time sober to actually reflect on what has happened to him and what the appropriate treatment is”

“What are the main risk factors for interpersonal violence? It's substance use and what I like to generally refer to as the criminal personality”

“There are ethnic groups that will have a higher risk of SJS, Steven Johnson syndrome, to lamotrigine, oxcarbazepine, carbamazepine, those kinds of things. Okay. And there is testing available to see if they have the gene that puts them at particularly high risk”

“SJS, same SJS risk. You can't tell if it's higher or not because they don't use oxcarbazepine as much as lamotrigine. Lamotrigine is used so much more that is then associated with a lot of SJS cases”

“It seems like giving antipsychotics to people without schizophrenia raises the risk of tardive dyskinesia”

“clinicians are underestimating the risk of antipsychotic treatment because antipsychotic treatment is so easy. You don't have to draw labs and it works really fast, especially inpatient. So everyone gets antipsychotic. But they have side effects. And the risk of tardive dyskinesia is higher in people who don't have a primary psychotic disorder”

“because chlorpromazine does hit the ham receptors. So it does have histaminergic alpha-1 and muscarinic problems. The reason why we call it first-gen is because it does also cause EPS. It does cause high risk of tardive dyskinesia”

“Do not dose-abilify above 5 mg if what you are trying to do is trying to treat major depressive disorder without psychotic features. Do not do it. Just don't do it. It's not worth it”

“So headache, nausea, muscle stiffness or soreness from the paralytic agent, nausea as you're waking up. And you should be confused after you're coming out of general anesthesia, but that confusion usually lasts 15 minutes or less”

“over 30%, so between 30% and 40% of individuals who are in the midst of their index series have a better mini mental status exam score despite seizures and anesthesia exposure by their sixth treatment”

“there's no absolute contraindication for ECT. However, anytime you have a seizure, you get a parasympathetic surge during the seizure itself. So your blood pressure goes low and your heart rate goes low”

“Anytime you're under general anesthesia, you may not operate a motor vehicle for 24 hours post-anesthesia. So ECT is not the right choice for people who are trying to actively work while getting treatment”

“A full-on light box at 18 inches is Can induce a manic episode. It's just, it's an antidepressant. So light is a powerful tool”

“these are harmless. How many treatments do we have in psychiatry? And these are robust treatments as the research literature shows. How many treatments do we have that are this robust? They have no side effects or long-term risks”

“The only harm would be if your bed partner is not on the same schedule and might not appreciate having this thing go off and then they need a sleep mask and you can continue to do what you need to do”

“if you are overly fearful or anxious about talking about this topic and thinking about this topic and assessing this topic, you are going to consciously or unconsciously show this to the patient”

“Asking about self-harm is standard. It should be standard in every single encounter with a patient”

“it's actually really doing a lot of danger because it teaches patients that like if I want to get discharged in the hospital I just have to answer these questions the way I know they expect to be answered and then I'm done”

“a resident, you go to start an interview with a resident and they go up to the patient and they go like, are you being suicidal? And then that's going to activate defenses”

“I'm less likely to jump in and say something by my own misinterpretations where it's like, oh, no, no, no. They, of course, discharged me”

“being honest with a healthcare provider of any kind is key for you to actually get better”

“you should avoid dysregulating the patient in the interviews, right? You're not doing a psychotherapy when you're doing a diagnosis. You're just trying to get information. And I will tell patients, listen, we're not here to get you sucked back into trauma memories”

“If you look at the research of Elizabeth Loftus, you, the clinician, can absolutely induce memories of traumas and abuse in your life. unknowing patients by suggesting them. Don't suggest that things have happened. Simply look to see if something has happened”

“I didn't say... You must have been abused or traumatized during that time. No, I said, you know, it's a little unusual. You told me about some traumas and you told me about a recovery from it. Yet, you know, three years ago, you started really declining and you didn't tell me about anything happening that year”

“any patient who evokes a strong pull to either rescue or over-involve yourself, or on the flip side, to detach and just give up on a patient. Those are the two things that he warns about”

“If you have intense counter transferential feelings of any type, that's a sign of self and interpersonal functioning. And that can, especially under distress, be quite dangerous”

“a patient who's not taking medication due to weight gain is a failed medication. And if GLP-1s can help prevent that, then it should be a part of our treatment plans”

“patients actually really like olanzapine. I know a lot of times we think of all medications that cause weight gain or have sexual side effects as like patients are going to hate it. Patients do report liking it”

“don't sugarcoat things um and also like allow like empathize with patients for how annoying these medications can be. I think it's helpful. I think you have to stay hopeful but also stay realistic”

“I literally say to the patients, like the way I think about it is we don't do labs because this medication is unsafe. It's because we're doing this labs, this medication is extra safe”

“even if you have guaranteed decline in renal function, that is not the same as renal failure, okay? And if you told me that over the next 20 years, I had the choice between 30% worse kidney function and 30% less brain function, I'll tell you this. I'm going to take the better brain function every single time”

“Sometimes with all this talk about hydration, when you first prescribe the lithium, people take it upon themselves to actively change their amount of water intake. I think I want to be clear to patients and say, you don't need to change what you're doing, but talk about any changes you notice at the next visit”

“I made a little page sheet that I share with the patient. And what I would do the first few times I prescribed lithium, and I still do this with patients that I feel like need to hear it. I share my screen and I walk through the, it's a Google Doc”

“We're talking about a rash that is new and that you haven't had before and that's different. If you get any new rash while we're starting this medication, I want you to stop the medication and go to the ER. That's how I do it”

“Incredibly, incredibly, incredibly sedating. Warn your patients that they will feel like a zombie. Now, why do I think it's important to warn patients”

“I pretty much say, hey, this works great for a lot of people. And for some people, it doesn't work at all and might even make the sleep worse. We don't know. Why don't you just try it out”

“if we are going to trial it, I recommend they try it for the first time on a weekend or something or when they have nothing to do”

“I say, look, I ask this of every patient, every time, every visit, and I really do. I make sure I do because I don't want that to be a lie because it is important to ask”

“often it's their support, the support around them, husband, wife, parents, that has the most resistance to the idea of doing ECT because they've heard that it's going to wipe out their memory, it's going to turn my loved one into somebody completely different”