I’m talking with Doctor Matthew Lorber, M.D., that’s L-O-R-B-E-R, Manhattan psychiatrist. Matthew, let’s give the audience a sense of your background, please. I want them to know who who they’re getting information from. You’ve been my psychiatric consultant for approximately 12 years. That is quite a statement. Can you tell the audience a little bit about your background, please? Sure, sure. And thanks for having me. And so I’m a child psychiatrist by training. I did fellowships at Columbia and Manhattan, and about 50% of the work I do are with children and teens. 50% are working with adults. I am a psychopharmacologist. And, much of, the patients I work with struggle with some sort of anxiety disorder.
Sometimes of social anxiety or selective mutism. That really ranges the gamut. I also do a lot of work teaching. I work with a lot of med students and residents and fellows in New York City, and, I work at a wellness center in Manhattan called Manhattan Mind, where I currently function as the president. There. Thank you for sharing. Okay. When I started my practice in 1978, I was doing biofeedback and therapy to help individuals with stress disorders get off medication and heal without meds, which was the foundation of a productive therapeutic skill set. That said, over 45 clinical years later and basically over 60,000 clinical hours later, I have learned that there are high performance ways to integrate psychopharmacology into treatment.
My objective today is to explain the methodology of pharmacological integration into what I reference as a high performance treatment plan for specifically social and performance anxiety. There’s a lot of ground to cover here. It’s critical to understand we are addressing a complex spectrum disorder. My two podcast spell this out and the degrees of functioning levels, they are public speaking anxiety and fear of being noticeably nervous. Mind surgery for high performers and parenting the socially phobic avoidant adult. In other words, we’re talking about the CEO of a major insurance firm making 6 million per year who suffers from public speaking anxiety, and the 26 year old, who is living in his or her room, married to the computer.
There’s so much confusion here. So, Matthew, can you please explain your pharmacological decision making progress process rather? Sure. And, you know, one of the reasons I’ve always like working with you, Jonathan, is because your, your idea or your approach really involves the cure. The cure, so to speak, is not coming with medications. And, you know, my approach mirrors that. It does not matter to me what type of anxiety disorder I’m dealing with. Whether it’s panic attacks, whether it’s fear of public speaking medications are not going to cure these problems. They can, however, bring anxiety down a notch that enables patients who are trying to overcome these types of anxiety disorders.
You know, in this case, you know, fears of public speaking, to tolerate the discomfort more and be able to do the work they need. And, that is what the role of the medications are. It’s to bring the anxiety down. At least, you know, at least one level to make it more, more possible, more realistic for someone to tolerate the discomfort, say, the discomfort of giving a talk in front of 1000 of your employees when you’re a CEO of a large company. You know, the idea of doing that without medications might feel like a ten on a 1 to 10 scale. As far as the anxiety goes with the medications. I’m prescribing it. I’m hoping maybe I could bring that discomfort down to a 6 or 7. And at that point, someone might be able to tough it out.
Now, when I’m deciding which medication to use, my first thought is always in the SSRI category. Medications that increase the levels of serotonin that are available in someone’s brain. Because, generally speaking, elevating serotonin levels help people to tolerate discomfort that comes with anxiety more. So from my perspective, 90 ish, 85 to 90% of the time, the SSRI does what it’s supposed to do. Okay. The other 10 to 15%, there’s a certain percentage where it does nothing, and then there’s a certain percentage where there are side effects which require, changing the medicine. But with the SSRI, there’s Zoloft, Celexa, Lexapro, Prozac.
Trintellix is there another one? Luvox. Fluvoxamine which is very famously given for OCD, but at times prescribed for social anxiety, fear of public speaking and performance anxiety. Okay, so so how do you sort this out? How do you decide which SSRI to do? Yeah, the reality is that the studies show that they’re all basically equally effective, as in, if I take ten people who have significant anxiety when being watched or observed. There’s not there’s not any statistically significant difference in the chances of, well, Lexapro will be more effective in bringing anxiety down than Prozac. Just the and that’s just an example. I could interchange any of the SSRIs. So basically one of the factors that goes into it, are side effects, because there’s a difference in side effects from one SSRI to the next.
There are differences in half lives. So for example, Paxil (Paroxetine) is an SSRI that is most likely to stimulate weight gain. That’s by both stimulating appetite and probably metabolically causing some increases in weight. So if someone is coming to me saying I really struggle, performing when people are watching, I really struggle speaking in front of my staff, but also my anxiety is so high that I’ve lost a lot of weight and I need to gain some weight, Paxil comes on the top of the list of medications because it is the one medication that’s most likely to do that. However, much more common is someone saying, I don’t want a medication that’s going to cause weight gain. So then I’m choosing based on medications that are weight neutral, something like Lexapro.
and Zoloft. So side effects are a big part of it. Those are examples that cause more sexual side effects. Some cause more gastrointestinal side effects. But Jonathan there’s also another factor with efficacy with effectiveness that comes into play. When a first degree relative has had a positive response with a specific antidepressant or anti-anxiety medication, or they’ve had very bad side effects to a certain anti-anxiety medication, then it’s there’s a much higher likelihood that the person I’m working with is going to either have a good response or a bad response. So if I’m seeing Linda, who tells me that her brother has done wonderfully on Lexapro, I’m going to choose Lexapro. However, if I’m seeing Linda, who tells me her sister, had severe nausea and vomiting from Prozac and then tolerated Zoloft well, then I’m going to choose Zoloft and avoid Prozac.
So that’s another major factor in how to choose A specific anti-anxiety medication in these situations. Okay. So take a look at the last 100 patients that you’ve had with social anxiety. I’ll put you on the spot. Which one of you prescribe the most? High between Zoloft and Lexapro. Okay. Why? Prozac is much more likely to cause sexual side effects for one, so that makes me less likely to choose Prozac. Also, Prozac has a very long half life. And if there is a problem, if someone has a bad reaction and a lot of these people are working with their teenagers or people in their early 20s where a bad reaction could be scarier, Prozac is their body for a week. So it’s going to take a long time before the bad reaction and a bad reaction can mean severe irritability and insomnia, before that resolves.
Paxil has a horrible withdrawal syndrome, and it’s also much more likely to cause sexual side effects. So, that leads to Lexapro and Zoloft, which are better tolerated. With Zoloft, they have more flexibility in the dosing. Some people I’m prescribing Zoloft to, it’s 25mg a day. Some I’m prescribing to it’s 200mg a day. So when I have the sense from doing an evaluation that someone is going to require more flexibility and more maneuvering with the dosing, I’m much more likely to choose Zoloft. However, if someone is very reluctant and they’re like, okay, the lowest is possible. And I recognize they’re not going to tolerate dose increases very often. I’ll choose Lexapro because Lexapro you really have two, maybe three choices, 10mg or 20mg.
You can prescribe 15. So, that’s someone where I’m going to more likely prescribe Lexapro. Because of the simplicity of dosing and not needing to make major increase of frequent increases in how much someone’s taken. Is Prozac the most energizing? Yes. And in the child psychiatry world, we call it activating. It’s kind of how my grandmother would have said I would act if I was given too much sugar by my parents. So for teenagers that energy, the energy you’re talking about can actually look like hyperactivity. So then it very well might be problematic. For adults, Prozac is the most likely medication to give a bit more energy, but that comes with it also being the medication most likely to cause insomnia.
So an adult who’s a great sleeper with low energy that has severe anxiety, is there someone who is perhaps more likely to get Prozac? Now, that being said, many of the people I’m working with with this fear of public speaking and performance anxiety, are struggling with sleep because they can’t shut their minds off, especially the nights before a presentation is coming, which also makes me less likely to choose Prozac, because the energizing benefit can be great. The insomnia A big problem. One of my patients a few years ago, a very successful guy, actually opened the bill on Nasdaq, had 500 employees, a 20 car garage. But major public speaking anxiety. So we decided that he was going to go for medication.
He’s in the southeastern Conference. He goes to his internist, who happened to be a friend, and the internist says, I know a lot about this. I’ve been on Prozac for ten years. What’s your response to that? Well, first off, the placebo effect of these medications is powerful. And that is actually something that’s quite useful when prescribing medications. That’s not you know, people look at that as that’s a negative. No, it’s not a negative. The fact that you feeling like something’s going to help you when much of this is about the confidence is a very positive thing. So if I have a primary care physician where their confidence in Prozac is high and it’s palpable, and they’re because I’ve taken this, it’s working well, that’s going to maximize the chance that the placebo response is going to work.
And I don’t think that that’s a bad thing. You know, if that’s leading to them prescribing Prozac as a first line choice, again, the efficacy of Prozac is just as good as the efficacy of Lexapro or Zoloft or Celexa. It’s just might be that slightly higher incidence of insomnia and, you know, sexual side effects with Prozac. You know, what do you think about ten years. Of being on it? It’s not necessarily a negative. You know, I think we might talk a little bit about benzodiazepines in the future, and it’s, you know, it’s dangerous to be on benzodiazepines long term. It’s not dangerous to someone’s physical health to be on an SSRI for a long time. Now my goal is to have my patients off of all medications.
You know, that’s the number one goal. That being said, if there is a patient who winds up on Prozac for ten years, especially if it’s not negatively impairing their sex life, I’m not concerned as far as their physical health goes. Now, it is tougher to get off of these medications the longer that you’re on them. And the reality is that more than 50% of the time, SSRI are going to cause some sort of impairment in sexual performance, which is likely going to lead to them coming off of them or wanting to come off of them. Also, if we’re dealing with females who want to become pregnant, they’re likely going to come off of them. So to me, the biggest danger for someone who’s on it in ten years, it’s going to be that much tougher to come off of it and withdrawals might be worse. So that is the biggest alarm.
And then again, there’s also the just the, the fact that I want the people I’m working with to say, I can do this without the need for medications. And the longer they’re on it, the more reluctant they might then become to trying to come off of them. Ultimately, when when I take a look at the last hundred patients that I’ve had, again, we’re talking about this, difference in functioning levels. The 26 year old is living in his room and these high performance, professionals. But looking at the high performance professionals for a moment, when I take a look at the last 100 patients that I’ve had, 20% have been able to get to a high level of treatment. Without medicine, 80% have needed it. And very specifically, what the medicine does, which is quite remarkable, is it lowers the obsessive worry with which gives the patient more of a chance to learn technique and doing, the deeper work.
Okay. There’s just so much information. You know, one patient came to me, he threw… a great athlete. He threw, two touchdown passes against Notre Dame on national TV. And when I’m starting treatment with him, it says medicine. I’d rather take heroin. Okay. Now he’s in the process of coming off an SSRI, and basically he has resolved his performance anxiety. Okay. So let’s go to the benzos. Okay. Anti-anxiety medicine. What’s good? What’s not good? Well, I suppose what’s good about benzos is that. First of all, name them, please. Yes. So Xanax, Klonopin, probably the two most popular Klonopin and the two most commonly prescribed Klonopin being much longer acting than Xanax.
Valium and Ativan are two others. Ativan, also known as lorazepam. Are two others. But I expect most people in these circumstances when they’re coming to me, if they’ve taken a benzo, they’ve been prescribed either Klonopin or Xanax by some prescriber in the past, you know, by a physician in the past. So the good there they the first time you take it, it’s effective. It’s nothing fancy about it either. They’re fairly potent. If I know that being said, a lot of the other things I would say are the negative. They’re very addictive. I worked on an inpatient unit in a hospital for years, and people would come to the emergency room so desperate for benzodiazepines that they would pretend to be suicidal just to get admitted, because that would mean a lot of access to Xanax and out of.
So they’re very, very addictive. In addition to being addictive tolerance and dependance, which I guess are, you know, part of addiction are major issues with benzodiazepines. So when I say tolerance, the more often you take them, the less effective they become. That means higher doses over time. If you want the same effect and then dependance, you feel like you can’t function without them. So then again, without them and all of a sudden your anxiety is going up. So that’s a real danger. They also, you know, are have some potential risks for memory long term. So, I mean, it’s one thing, if you’re going to take a benzodiazepine twice a year. In the two days you fly, you know, to another continent.
But if you’re going to be taking them on a regular basis, they’re very real worries, about starting to have memory problems. Benzodiazepines. Also, they work on the same part of the brain as alcohol. Their mechanisms are similar. So I’ll tell Patients were coming to me asking me for Xanax when they’re afraid of a, speech that they’re going to have to give me. You know, it’s not that different. Then if you were going to go and have a glass of wine, now they’re able to understand, especially when they’re younger. But what the problems are, if you’re going to depend on a glass of wine for something like that, they’re in essence enabling avoidance, because they’re a way where you’re not feeling the discomfort at all, and then you’re not learning to be able to tolerate the discomfort.
So, you’re talking about something that can be addictive. You’re talking about something that’s going to become less effective over time. And the more you use it, the less effective it will be where you’re going to have to start going to higher doses if you want the same effect. And, talking about something that can have negative impacts on, on memory and, I also think that in some ways they could sabotage the therapist from being able to do the work that they’re trying to do. That’s vitally important with their clients, because instead of using the skills that they’re being taught, oh, just take a Xanax and just recover it. And now it’s making the job of the therapist tougher. And it’s certainly making it tougher for the person who’s doing that to really work on the skills and start being better apt at tolerating the discomfort that’s necessary, really, to survive, you know, to survive in life.
Okay. That brings us. Yeah, I mean, again, there’s so much information to cover here. That brings us to beta blockers. Okay. So the good the not good about beta blockers. And then I’ll chime in. Yeah. So there’s some significant advantages to that in my opinion to beta blockers over benzodiazepines. And those all lie in safety. Okay. There like I said before there’s some real dangers. And taking Xanax or Valium. Beta blockers, On the other hand, propranolol being the most popular, also known as Inderal, That one that’s safe. Propranolol. There’s no addictive. worries. You don’t have dependance. There’s not tolerance. So you’re not running the patients, not running into those problems of, well, now they’re going to be asking, I’m not going to be getting a call from them.
Oh, I, I lost, you know, my, Xanax. I got flushed down the toilet. I need a new prescription. The reality is probably they started overusing it. Beta blockers don’t have a high, and you don’t have the dependance or tolerance. So on a safety standpoint, there’s a huge benefit. Also, what a beta blocker is doing primarily it’s well, there’s a few things actually. It’s preventing blood pressure from going from becoming significantly elevated. And it’s preventing heart rate from increasing. A lot of the patients I’m working with, they’ll describe these physical symptoms that then sometimes trigger some of the, some of the more mental symptoms. You know what’s adrenaline really? I’m saying it’s adrenaline running through the body. So if I’m giving a talk in front of 200 people, and then my heart’s thumping, and then I might start sweating and I might start becoming shaky, and now I’m nervous that people are noticing that I’m sweating.
I’m nervous that people are noticing that I’m shaky. And this is making the entire experience that much worse. The beta blocker controls or helps to regulate those physical symptoms. However, it’s not really removing the discomfort, the emotional discomfort that someone’s feeling. So they’re still having to learn how to tolerate that discomfort. It’s not necessarily enabling the avoidance of feeling the discomfort. It’s just focused on some of the physical symptoms. That exacerbate anxiety. So I am more comfortable with people using beta blockers to help as one of the tools compared to a benzodiazepines. There’s an interview on my website called, High Performance Use of Beta Blockers, And the person in question describes how everybody creates their hierarchy of anxiety.
And this person was saving the beta blocker for level eight and above. The problem with beta blockers… they are effective, And the problem with beta blockers, however, given my treatment methodology, is that it’s very hard to surf, which is the primary technique of, adrenaline acceptance because the beta blocker is so good at blocking it out. Okay, so I have seen in a number of cases lately, complex cases, that you have prescribed Auvelity. Yes. Interesting stuff. What’s that about? So for over 60 years, all of the daily anxiety medications did basically the same thing.
And that was increased levels of serotonin. They also increased levels of something called norepinephrine. Some of them, but really when helpful for anxiety, what they were doing is increasing serotonin levels, which, you know, can, be a bit relaxing. That’s why when you asked me before, the difference between choosing Lexapro or Zoloft, you know, they’re all really the same. Yeah, some increased serotonin by preventing the reuptake, some increased serotonin by causing more serotonin to be released out of pumps that are in the brain. But it’s the same. It’s basically the same idea. That changed back in the end of 2022 when Auvelity was, approved. And it was the first oral medication of its type that works on something called glutamate, which is a neurotransmitter in the brain.
That’s primarily what it does. It’s working in modulating glutamate, not just serotonin. Now, glutamate is the neurotransmitter responsible for learning. It’s the neurotransmitter primarily responsible for cognition and memory. It helps, to stimulate a process called neuroplasticity in the brain. And synaptogenesis, kind of it’s a 60 year old is learning a new foreign language. You’re depending on neuroplasticity, new circuits, new ways of learning. Being built into the brains Auvelity is assisting with this process. So it’s doing a heck of a lot more than just decreasing discomfort. It’s actually helping people to learn. That’s helping people to learn new coping mechanisms. That’s helping people to learn how to manage adrenaline, like you said before.
I like to use the word, you know, surfing. And it’s helping these new memories to be built. So if I have someone who the idea of giving a talk in front of 1000 of their employees is a ten, and it’s on a 0 to 10 scale as far as fear goes. And it’s been a ten for the past 20 years of their life. Taking over it might help them to start building new circuits where they’re no longer thinking about this as something that’s so terrifying, but they’re learning. Okay, maybe it’s not so dangerous for me to give a talk in front of all of these people. Maybe nothing bad will happen. So it’s really assisting a therapist in doing the work that they’re doing. Because it’s allowing for more neuroplasticity. It’s allowing for patients to learn new ways of coping and new ways of thinking about something that used to seem so terrifying.
Public fear of speaking. What family of medication Is it? It’s unique. It’s. Its own medication. It’s known as an NMDA antagonist. Or really what I would call a glutamate modulator, as opposed to SSRI, which are serotonin modulators. As an SSRI is working on serotonin receptors. This is working on glutamate. And by the way, Auvelity does also lead indirectly to more serotonin available on the brain. So you start getting a little bit more serotonin. So you’re getting that benefit. But the primary magic of what Auvelity is doing is working on glutamate. And science is also showing, that the pathology behind certain anxiety disorders, as far as the biologic pathology lies in problems with glutamate.
It’s not a serotonergic problem. People with anxiety. We used to think, oh, maybe there’s something wrong with their serotonin pumps. No, what science is now showing is glutamate is really the key. That also goes for treating depression. I said this was complicated stuff. What about Pristiq? Yeah. So Pristiq belongs in a class of antidepressants known as SNRIs. Effexor and Cymbalta, two other popular SNRIs. So Prozac and Lexapro. They’re increasing serotonin levels. SNRIs, The S stands for serotonin. The N stands for norepinephrine. So they’re increasing serotonin levels and norepinephrine levels. Norepinephrine is responsible for making something called noradrenaline or adrenaline.
So I think it’s easy to think of it as a it’s increasing adrenaline. Now it’s counterintuitive. Why would something that’s increasing adrenaline, norepinephrine help for someone with a fear of public speaking? Well, for a lot of people, they don’t. In fact, for a lot of people SNRIs, Pristiq, can make it worse. However, low doses of Pristiq and also low doses of something called Effexor, which I consider Pristiq’s brother, they primarily increase serotonin and just very minute levels of norepinephrine. I, you know, Jonathan, when we started, I talked about my own anxiety of technology. Well, I just got logged off of, you know, logged off, so that doesn’t help. That’s okay. We can have a sense of humor. I just had an adrenaline blip. Listen, I literally have technology PTSD. That is, I mean, it’s no B.S., man.
I’m very afflicted. Okay, Jonathan, I could take up two hours of this talk to talk about my previous negative interactions with technology and the embarrassment that it’s caused me, and not to mention the problem. So yes, I do too. Well, somebody very smart, said to me about 20 years ago, get ready for e-commerce. Gee, What’s that? Well it’s wonderful, you know, now I can see patients around the world from my home office. You know, no viruses, except on the computer. No germs, no snow days. But boy, oh boy, the technology can become overwhelming. Oh, Jonathan, I have vivid, I have vivid memories of learning about Google from you. And I think it was over ten years ago. Yes, yes. Okay, so, look, we’ve been talking about a lot of performance anxiety, public speaking anxiety. What about the 26 year old who’s not working?
Not socializing for the most part? There’s variability to everything. And he or she is living in the room, married to the computer. There’s a good bit and certainly in some cases, there’s a lot of cannabis and other cases there’s a lot of alcohol. There’s always technology over dependance, as in a literal addiction. How do you dissect this in terms of where you go with pharmaceuticals? Yeah. So, if there is a what I consider, a primary substance problem or even if it might be secondary, for example, cannabis dependance that’s crossed the line where it is, sabotaging motivation, then I frequently won’t prescribe medications simply because they won’t, They won’t work.
Medications are limited in their effectiveness to begin with. They are not necessarily strong enough to overpower the dependance. And for some, with severe cannabis dependance, I mean, of their loss of motivation. And I don’t want to give someone the wrong idea that this medication is going to help you to achieve your goals, when the reality is that getting over an addiction is the necessary step. Before maybe concerning medications, if one wants to, reach their goals, such as not being bound to their room at 26. But what if every doesn’t… I don’t mean to cut you off, but what if the person doesn’t have any goals? They’re incapable of initiative for their mental health. That’s the whole podcast of Parenting the Avoidant, Socially Phobic Adult.
These individuals do not have initiative. They don’t care. They’re only care is they want to be safe. And they only think about today. You know, a lot of it depends upon what you know, what’s behind them Not wanting goals. And if what’s behind it is a combination of anxiety and depression, whereas the anxiety is leading to some avoidance and the depression is also leading to, loss of motivation. Well, then the medication potentially can give a little bit of a motivation burst and an energy burst that hopefully can over help them to overcome Some of the stuggles they are dealing with, With dependance. However, there are some real dangers. If we’re talking about excessive alcohol and SSRIs.
So in a circumstance like that, and certainly if we’re talking about drugs that are harder than marijuana, LSD, just as an example, if there’s a danger, then medications are just not an option in the sense that there could be an interaction between the substances and the medications. if there’s not going to be necessarily a danger of medications interacting with substances in, in a way that’s going to be harmful to their body, then perhaps medications to give a little bit of a burst in motivation or energy levels so they can start working on the addiction in addition to working on the other problems. Yeah, what do you say to the 26 year old who tells his parents, cannabis is the only thing, the only thing that makes me feel okay? I mean, he’s basically nonfunctional, but he’s making that statement.
I’ve seen that countless times. Well that’s an easy question, actually. I tell the parents and the person I’m working with, you’re going to have to talk to Jonathan about this. You know, you know, it’s it’s working with where patients at, if I recognize that this person is going, is not going to cut back on marijuana at all, and the parents are not going to be able to do something, you know, the parents are not going to be able to stop the marijuana use. Then I’m providing expectations that are realistic that the ceiling of success that someone’s going to reach from these medications, while that level of marijuana is going on, it’s going to be limited. But I’ll hopefully come to a compromise. Well, let’s work on cutting back on the marijuana use at least because I do think that there are a lot of teenagers, I mean, people in their 20s, I mean, where they will say this marijuana is helping my anxiety like nothing has before, but I might be using too much and at the levels I’m using, maybe it is harming my motivation a little bit, and I’m open to the possibility of cutting back.
And if they’re open to the possibility of cutting back, I’m having conversations with them about the medication, doing some of the work, so to speak, that the marijuana was doing as in bringing down the anxiety a little bit. So then they might not need they might feel as though they don’t need as much marijuana as they’re using. But it’s certainly tough. And I mean, the reality is that in some ways, marijuana isn’t an anxiolytic, at least for some people. And, it’s the coping mechanism that people have been using for a long time. I do have to be realistic, as to where someone’s at and what they’re going to be willing to do, and changes with medication and changes with the amount of substances that they are using. Okay, a couple more quick questions. Going back to an SSRI in performance and public speaking anxiety, you would advise the person to limit their alcohol for to for efficacy for the medicine, you would say no more than how many units per week?
That also really depends on the person you know. The biggest risk with alcohol and SSRI is you know, it’s, severe, a severe hangover. That’s a medical phrase, you know, the day after. But on the SSRIs could be a little dehydrating. The alcohol is dehydrating. If they’re not drinking enough water, they could wind up with a really severe headache. Really nauseous. Really. Bad stomach aches the next day. It really does vary based from person to person, as far as their own levels of tolerance that they have with alcohol. There’s not a cut and dry. If you’re drinking four drinks a day, you can’t have an SSRI. It’s working with the patient towards moderation and moderation with the amounts of alcohol that they’re using. Okay. What?
Okay. Changing subjects for a moment. Why is Prozac the drug of choice? I don’t mean to keep pushing Prozac. Yeah, that’s not my objective. Okay, but why is Prozac the drug of choice for selective mutism? Well, it’s not it’s not even. It’s not black and white. That Prozac is the drug of choice for selective mutism. However, the majority of people I’m working with with selective mutism are very young. Five, six, seven years old. So for one, Prozac has been studied in children, for a long time, and it’s FDA approved down to the age of six. So at least here you have a medication that’s got 30 years of data of seeing this used in children.
It’s been studied. The FDA has said it’s safe in children. So there’s safety reasons right off the bat. Prozac also comes in a liquid form which provides two major benefits. One for children who don’t know how to swallow pills or don’t want to. Prozac can be mixed in their apple juice. Liquid Prozac can be mixed in their apple juice, so it makes it very easy for a child to be able to take as opposed to. Yeah, so it allows for Prozac to be easily consumed for a child who doesn’t, who doesn’t want to take pills, doesn’t know how to swallow pills. And it also allows for an increase in flexibility in dosing so I can prescribe minute doses of Prozac to a six year old where it’s the equivalent, you know, the FDA approved dose for an adult, the Prozac is 20mg with liquid Prozac.
I can actually give them one milligram. So it allows for microdosing, which really makes it much safer. And allows for the tolerability. And then the other, you know, the other advantage as far as Prozac, cause it’s something we spoke about, it is activating, and with selective mutism lots of times I see children staying in bed trying to refuse to go to school. It might help to give them more energy in order for them to get out of bed and get to school. So there’s that third benefit. Wow. Okay, so we have covered a lot of ground here. So prescribing obviously is no easy thing. It becomes an art and a science. And you want to go to someone if you’re considering medicine you need someone with a lot of experience.
There’s so much comorbidity and diagnostic intersections. My philosophy is to use medication to enhance therapy to achieve objectives, and then not to need the meds anymore. Of course, this is not possible in many cases for a variety, a variety of clinical issues, but this was really good. Matthew. We’re going to have to do another session some time. But I thank you very much for your time and your expertise. Yeah, that sounds great to what you just said, Jonathan, for all the families coming to me or all the adults coming to me, I tell them to view the medication as a protein shake for someone who’s trying to get strong in the gym and to view the work they’re doing with the therapist, the work they’re doing with you, that’s the gym trainer. That’s the real important work. Not everyone needs a protein shake in order to put on the strength that they want at the gym, and just taking a protein shake and not going to the gym is not going to do it. But sometimes the protein shake may be necessary if you want to really reach certain gains, which I thought I’d love for us to be able to talk about this more. Thank you so much for having me. We’re going to do it again. Thank you very much. You’re welcome. Bye.
