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PMDD stands for premenstrual dysphoric disorder. This is not to be confused with Premenstrual Syndrome or PMS. PMS is changes in mood during certain parts of the menstrual cycle. It affects 80% of women. The mood changes can be mild to moderate. In fact, some women will just see it as feeling a little moody the week before their menstrual cycle. PMDD is a severe form of PMS. It’s almost like turning into the werewolf when the full moon rises. For some people, it’s just that drastic. It affects 3% - 8% of women. So it’s not as common as PMS. We treat PMDD with antidepressants or hormone therapy. I show you why some women get PMDD and why the antidepressants help. I discuss the difference between intermittent and continuous dosing with antidepressants. I also discuss the two main hormone treatments. If you do not want to take any kind of medication, you can try lifestyle changes. The first are diet modifications such as eliminating caffeine, sugar, nicotine and alcohol and minimizing sodium. You would combine this with sleeping 7-9 hours a night and getting regular exercise – like 3-5 times a week. Some nutritional supplements have shown to be helpful. These would be Calcium 1200mg/day, Vitamin B6 50-100mg/day. Other supplements would be Magnesium 200 – 360mg/day, Vitamin E 400 IU/day. There are some herbal remedies that have been shown in studies to be helpful. Agnus castus fruit extract, also known as chasteberry and Gingko biloba. To download the mood diary go here: http://markspsychiatry.com/mood-diary/ Video on Brain Zaps from medication withdrawal http://www.youtube.com/watch?v=KrcUEarpx-s Want to know more about mental health and self-improvement? On this channel I discuss topics such as bipolar disorder, depression, anxiety disorders, attention deficit disorder (ADHD), relationships and personal development/self-improvement. If you don’t want to miss a video, click here to subscribe. https://goo.gl/DFfT33 References: Article about how SSRI’s increase allopregnalone Griffin LD, Mellon SH. Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes. Proc Natl Acad Sci U S A. 1999;96(23):13512–13517. Bäckström T, Bixo M, et. al. Allopregnanolone and mood disorders. Prog Neurobiol. 2014 Feb; 113:88-94. Epub 2013 Aug 23. Schiller CE, Schmidt PJ, Rubinow DR. Allopregnanolone as a mediator of affective switching in reproductive mood disorders. Psychopharmacology (Berl). 2014;231(17):3557–3567. doi:10.1007/s00213-014-3599-x Griffin LD, Mellon SH. Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes. Proc Natl Acad Sci U S A. 1999;96(23):13512–13517. Khine K, Rosenstein DL, Elin RJ, Niemela JE, Schmidt PJ, Rubinow DR. Magnesium (Mg) retention and mood effects after intravenous Mg infusion in premenstrual dysphoric disorder. Biol Psychiatry. 2006 Feb 15;59(4):327-33. Yonkers KA, Pearlstein TB, Gotman N. A pilot study to compare fluoxetine, calcium, and placebo in the treatment of premenstrual syndrome. J Clin Psychopharmacol. 2013 Oct; 33(5):614-20. Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.

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In this week’s episode, Dr. Mary and Dr. Lucy continue their exploration into the world of supplements. The spotlight is on the fascinating compound Berberine—a natural supplement that’s gaining widespread attention for its potential to improve insulin resistance, support cholesterol management, and enhance overall metabolic health. Listeners will gain a deeper understanding of how Berberine works, its science-backed benefits, and practical tips for incorporating it into a health-focused lifestyle. Berberine Overview ✨ Origin: A bioactive compound extracted from various plants, particularly the barberry plant, used in traditional Chinese and Ayurvedic medicine for centuries. ✨ Mechanism of Action: Activates the AMPK pathway, a critical regulator of cellular energy metabolism, improving how the body processes and utilises energy. ✨ Modern Interest: Recently studied for its effects on metabolic health, including insulin resistance, type 2 diabetes, obesity, and cardiovascular health. Key Benefits ✨ Improved Insulin Sensitivity: 📍Enhances glucose uptake into cells and improves insulin signalling. 📍Similar to the effects of metformin. 📍Supports better blood sugar control and energy utilisation. ✨ Anti-Inflammatory Effects: 📍Reduces inflammation by inhibiting inflammatory pathways and cytokines. 📍Breaks the cycle of insulin resistance and inflammation. ✨ Cholesterol Management: 📍Lowers LDL cholesterol by inhibiting PCSK9 enzymes. 📍Promotes better cholesterol recycling and utilisation. ✨ Gut Microbiome Health: 📍Encourages growth of beneficial gut bacteria, similar to metformin. 📍Influences metabolic health positively via gut microbiome changes. ✨ Liver and Muscle Benefits: 📍Helps the liver process glucose more effectively. 📍Improves glucose utilisation in muscle cells. ✨ Polycystic Ovarian Syndrome (PCOS): 📍Improves ovulation by enhancing insulin sensitivity in ovaries. 📍Potentially aids fertility when combined with other ovulation-inducing medications. Safety and Considerations ✨ Side Effects: 📍Common issues: Diarrhea, constipation, and stomach cramps. 📍Shares similar gastrointestinal effects with metformin. ✨Interactions with Medications: 📍Metabolised via the CYP450 liver enzyme system. 📍Potential interactions with other medications processed by the same pathway. 📍Caution for those on glucose-lowering drugs due to potential low blood sugar risks. ✨ Pregnancy and Breastfeeding: 📍Lack of safety data for use during pregnancy or breastfeeding. 📍Should not be used due to potential risks to the fetus or baby. ✨ Illness and Stopping Use: 📍Like metformin, berberine might need to be stopped temporarily during significant illness to avoid complications like acidosis. ✨Product Quality: 📍Supplements vary widely in quality. 📍Avoid products with additives like maltodextrin, sunflower oil, or high alcohol content. 📍Choose supplements with minimal, clean ingredients. ✨ General Recommendations 📍Treat berberine like a medication: targeted, monitored, and with medical supervision. 📍Take it with food for the best absorption. 📍Not a standalone solution: Combine with lifestyle changes for best results. 📍Avoid excessive or unmonitored use to prevent potential risks. ✨ Final Verdict 💃 Cautious Yay: Promising benefits backed by solid evidence for improving insulin resistance and metabolic health. 💃 Supervision Advised: Should be used thoughtfully, particularly if combined with other medications or for specific conditions like PCOS or diabetes.