I surprised myself on this one with a vicious rant about Makena, a synthetic intramuscular drug FDA approved in 2003 for preterm labor that was recently recalled in 2023. I get pretty elevated in my 8-minute rant introducing this segment and talking about the implications of the Makena catastrophe. Other than that, we talk about other failed treatment options for menopausal or postpartum symptoms, as well as the content of psychosis in patients, and how that content has changed historically based on societal values, norms, and fears of new technologies. Hope you enjoy! Follow RenegadePsych if you're not already.
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Disclaimer, this podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials should be treated as a substitute for professional medical or psychological advice, diagnosis or treatment. All listeners should consult with a medical professional, licensed mental health provider or other healthcare provider if seeking medical advice, diagnosis, or treatment.
[00:00:00] In this extra segment, I skip around
[00:00:02] to various parts of my conversations
[00:00:05] with Dr. Wood and Dr. Greider.
[00:00:07] First, Jenny and I talk about problems
[00:00:09] with a couple of new treatments for menopausal symptoms
[00:00:12] and postpartum depression.
[00:00:14] Then Anne and I do the same talking about the farce
[00:00:17] of bioidentical hormones and how some
[00:00:20] of the newer menopause treatments
[00:00:22] don't necessarily offer many additional benefits
[00:00:26] compared to using tried and true hormone therapy. It's an intramuscular injection that was used to prevent preterm labor in pregnant women. A small company called KV Pharmaceuticals ran a clinical trial in 2003 showing a reduction in preterm births, but notably no positive impact on overall morbidity and mortality results,
[00:01:40] which is obviously the most important measure
[00:01:42] for a drug with this indication.
[00:01:44] The FDA allowed KV Pharmaceuticals and Makana 1100 receiving mikana and found no difference in reduction of preterm labor and didn't even find the original difference in reduction of preterm labor that the clinical trial did compared to placebo. And the FDA advisory committee said the drugs approval should be revoked. That was in 2019.
[00:03:00] Between now and then, adicannumab its lack of efficacy to the FDA, publishing his findings in whatever medical journal would publish to them, and even organizing a citizen's petition, clamoring that it was not only ineffective,
[00:04:21] but actually might be leading to worse outcomes
[00:04:23] for infants and mothers.
[00:04:25] O'Rato says that the randomization doing right by their patience. Urado claims a superior even sat him down to notify him. He was not using the drug enough and that it was outside the standard of care. A sentiment that Dr. Greider echoed to me. AMAG pharmaceuticals ended up making, according to Urado, more than a billion dollars off the drug.
[00:05:41] It remained on the market for far too long infants. It didn't work out for the average maternal fetal medicine patient that took it. And it's really fucking sad that we live in a medical society where even babies dying
[00:07:00] or having lifelong developmental complications
[00:07:03] from bad medicine is not incentive enough
[00:07:06] to correct our mistakes. Somebody get this guy some help. And you know the other factor here is that you and I are intellectually motivated to learn more about this. But in terms of actual data and setting up a
[00:08:20] study, most of those may not actually be any
[00:09:43] Legitimate role for it when you just have the hormone to give anyway
[00:09:47] There's all these drugs that affect estrogen in that system cost $15,000 and you could probably just give the natural hormone to restore a balance and it would be $10. I think it's really important Sarati delivered the second baby, she started posting things indicating how depressed she was. She didn't outright say it, not as severe as initially. And then she got on oral pills. And she had an OB that was willing to do hormone therapy with her. And next thing you know, she's right back to her bright and bubbly self.
[00:13:41] And I've wanted so bad to have her on here because she's had the experience and she could postpartum depression and other things like PTSD as well. I don't know more than that. A lot of things come up now with like bioidentical hormones. With today's marketing, there's a lot of misleading information that bioidentical is synonymous with compounded. So it sounds really good. You go to a compound in pharmacy and you get a little special
[00:15:01] concoction made just specifically for you. But I do bioidentical without doing compound is the Oza and it is a neurokinin. Is that the brand? Yeah, the Oza is the brand. How does it work? In the area of the brain that deals with thermal regulation, you have the neurokinins and you have the estrogen. And so estrogen is the turn the thermostat down.
[00:16:20] Is it like the hypothalamus?
[00:16:21] Hypothalamus.
[00:16:22] And the neurokinin is turn the thermostat up
[00:16:25] and they balance those estrogen receptors. So we haven't yet come up with the perfect serum that in all the areas that we want
[00:17:42] estrogen stimulation, it's a good effect goes through the same learning process about these things, but also directly firsthand experiences that transition, it just makes so much more sense for them to be making the consensus decisions about the safety and efficacy of hormone therapy.
[00:19:00] Do you see any of that playing into this historical trend against hormone therapy?
[00:20:03] the amount and the quality of life that you have in the postmenopausal years.
[00:20:06] And I think too that for patients when I say,
[00:20:08] this is what I'm doing, then they say, okay.
[00:20:10] When I'm having such a hard time
[00:20:13] convincing somebody that even just taking a lithium supplement
[00:20:16] might help stabilize their mood
[00:20:18] and help a whole lot of other things.
[00:20:20] I've gotten to the point where I tell them,
[00:20:22] yes, I do take one.
[00:20:23] You say lithium and everybody thinks,
[00:20:25] oh my gosh, these horrible side effects deproclinically whatever, but is it just like improves? That is still up for debate. There are some very well respected psychiatrists who think that it has benefit for everybody in terms of mood. There's others that think it's isolated to bipolar populations, but we're also talking about, you know, condition, bipolar that it's on a big spectrum.
[00:21:42] Yeah.
[00:21:43] So it's kind of like what we were talking about with women who do get psychotic.
[00:21:46] There's a predisposition. And then you have to use your experience good or bad. What my patients get is somewhat based on my experience of things and then my interpretation of things, and my trying to do my best, trying to sort through and make sure that what was in our train and really is the right thing.
[00:23:02] Just to veer off course for a second, and you'll see the relationship here,
[00:23:04] but I was treating a old and my dad coming out and shooting it in the head with a shotgun went on to tell another story about being pregnant and her dad and brother sounds like teased her a little bit they had her get on a boat and went down one of the most snake-infested
[00:24:20] rivers in their area she said snakes dangling and falling from the trees
[00:24:25] into the water that you're traversing through so this was something that answering questions. And I'm sitting there like, I think this might be what schizophrenia looks like. I think he was 18 years old at the time. And then he starts looking at one of the social workers. And he's like, get your fucking hands out of your pants. Stop touching yourself. And it goes on. And we have him leave the interview room because he's getting a little
[00:25:42] unstable and running the risk for heaven and outburst. And he gay. To this day, now I've heard it multiple times with young people who turn out to be schizophrenic. They are having hallucinations that a man is trying to hit on them or trying to make sexual advances towards them. I'm sitting there, I'm like, I think this guy is schizophrenia and I don't know, but I just have that feeling that sense. We end up discharging
[00:27:01] him. Three years later, I'm working at Central who were very wary in the general public about glass, but not to a psychotic or delusional degree. The same thing LGBT have been ostracized and prejudiced against for a long time. And that stuff
[00:29:28] of their brains, but animals don't really commit suicide. Animals don't really get psychotic unless there's an explanation like a rabies or something medically or
[00:29:35] organic that's going on. And so for me, back to the drawing board, what is the
[00:29:41] human psychological experience? I have a do, which the list in the world of the internet and our phones is
[00:32:05] patients that I see in our society in general, we're kind of taught that our mind is supposed to be this positive influence in our lives and there are
[00:32:09] positive aspects to it because part of survival is coming up with new ideas
[00:32:15] and ways to optimize not just things to avoid but that kind of adds a little
[00:32:22] description of the human experience and why we feel so attacked by our minds control understanding and power over that. So yes, I use that technique a lot too. Yeah, yeah, just giving conscious control to make those decisions. Somebody get this guy some help!
[00:33:45] Thanks for listening. For more social media content, check us out on all social media platforms at Renegade Psych. If you have any comments, questions, or challenges to the information we presented here,