Ep. 012 - How to reverse weight gain from antipsychotic medication?
Ask A Psychiatrist
This episode deals with the question of weight gain from antipsychotic medication: I'm on 20 milligrams of olanzapine. It's helping me and I don't want to change it. The only thing is that I've gained a lot of weight that makes me feel very unattractive. I’ve spoken to my psychiatrist about it, but I haven't gotten any guidance on the matter. Are there any solutions to weight gain from this kind of medicine? Modern antipsychotic medications can be very helpful for some people. And they are less likely to cause neurological side effects, compared to their first-generation predecessors....
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Ep. 011 - What is akathisia, and how to stop it?
Ask A Psychiatrist
What is akathisia? Akathisia is a relatively common medication side effect. Akathisia is a feeling of restlessness that many people find difficult to describe. Many people with akathisia say that it makes them feel like they would like to crawl out of their skin. What does akathisia feel like? Akathisia can be just an uncomfortable feeling. But for many people that feeling of restlessness translates into not being able to sit still. (Akathisia comes from Greek words that mean “not able to sit down”). It can involve fidgeting, or not being able to sit down or lie down for very long...
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Ep. 010 - Lack of insight into mental illness: Are there any new leads?
Ask A Psychiatrist
This week’s listener question was “is there any new research about curing anosognosia?” Anosognosia is a medical term derived from Greek root words that mean “lack of disease knowledge.” Although anosognosia started off as a neurological concept, it's also very common for people with psychiatric conditions to have no awareness that their symptoms are unusual, or that they could indicate the presence of a mental illness. Emerging data suggest that impaired insight in mental illness might -- like neurological anosognosia -- involve those outer layers of the right side of the brain. It...
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Ep. 009 - Can Antidepressants Reduce Self-Harm?
Ask A Psychiatrist
Can Antidepressants Reduce Self-Harm? Self-harm is a common behavior. About 1 in 8 children and up to 1 in 5 adolescents will deliberately injure themselves without suicidal intent. But even without suicidal intention, self-harm is an alarming and potentially dangerous behavior. Self-harm is a sign that something is wrong… but what’s the best way to help? It’s not uncommon for someone with self-harming behavior to be prescribed an antidepressant. Most of us would think that someone who is repeatedly harming themselves is very sad or depressed. So, it’s not surprising that doctors might...
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Ep. 008 - What is Cannabinoid Hyperemesis Syndrome?
Ask A Psychiatrist
Cannabinoid Hyperemesis Syndrome (also called CHS) is the topic of this week’s episode. Melissa and Dr. Erik answer the question “How can something that’s an anti-vomiting medicine be the cause of a vomiting illness”? Cannabinoid hyperemesis syndrome involves symptoms like loss of appetite, stomach pain, nausea, and vomiting. Vomiting attacks come in waves or cycles. A vomiting attack can last many hours or several days and can be severe enough to cause dehydration or a host of other serious complications. Cannabinoid hyperemesis syndrome affects some people who use...
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Ep. 007 - Is it possible to prevent Alzheimer’s disease?
Ask A Psychiatrist
In this episode, Melissa and Dr. Erik discuss Alzheimer’s disease and address the question of whether it’s possible to prevent Alzheimer’s disease. What is Alzheimer’s disease? Alzheimer’s disease is one of several causes of dementia. The American Psychiatric Association has renamed “dementia” and now refers to this type of condition as “Neurocognitive Disorder.” Either name refers to a decline in cognitive performance. “Cognition” is a broad term which can include things like: attention, decision-making, recognition of language, faces, or situations, learning, or...
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Ep. 006 - Are There Any Medications to Treat Alcoholism?
Ask A Psychiatrist
At least 1 of every 20 adults has an alcohol use disorder. The average life expectancy of a person with alcohol use disorder is shortened by about 29 years.
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Ep. 005 - What is borderline personality disorder?
Ask A Psychiatrist
This week’s podcast episode focuses on borderline personality disorder. Borderline personality disorder is a common condition Borderline personality disorder is relatively common. It’s a condition that currently affects about 1 out of every 60 people (). Up to 1 of every 20 people may be diagnosed with borderline personality disorder at some point in their lives (). “Borderline personality disorder” is a terrible name Dr. Messamore starts off by pointing out that the name of this condition – “borderline personality disorder” – is long overdue for change. It is based on...
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Ep. 004 - What is psychosis?
Ask A Psychiatrist
Psychosis is a word that gets spoken a lot, but that gets discussed very little. About 1 of every 11 people will experience psychosis at some point in their lives. But even though it’s a common experience, we hardly ever talk about it. In this episode of Ask A Psychiatrist, Dr. Erik Messamore and Melissa Xenophontos discuss psychosis. Dr. Messamore explains what psychosis is, how it happens, and what to do about it. We learn that it’s easier to understand – and probably more accurate – to think of psychosis as a misperception syndrome. Psychosis by itself is not a standalone diagnosis....
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Ep. 003 - Does therapy help?
Ask A Psychiatrist
There are so many forms of therapy today that it can be hard to decide which is best for you. One of these types is “psychotherapy,” which sounds a lot scarier than it is. In this episode of “Ask a Psychiatrist” we learn about what psychotherapy is, how it can benefit your thought life, and why fears about undergoing psychotherapy still persist. Dr. Erik Messamore explains the history of psychotherapy and how Freud’s findings dominated professional psychiatric thinking for decades. After about the 1960s or so, Dr. Messamore explains, psychology underwent enormous strides to get us to...
info_outlineCannabinoid Hyperemesis Syndrome (also called CHS) is the topic of this week’s episode.
Melissa and Dr. Erik answer the question “How can something that’s an anti-vomiting medicine be the cause of a vomiting illness”?
Cannabinoid hyperemesis syndrome involves symptoms like loss of appetite, stomach pain, nausea, and vomiting. Vomiting attacks come in waves or cycles. A vomiting attack can last many hours or several days and can be severe enough to cause dehydration or a host of other serious complications.
Cannabinoid hyperemesis syndrome affects some people who use cannabis regularly. The typical CHS patient will have used cannabis nearly daily for several years. However, there are cases of CHS developing in people who have used it as little as once per week for 6 months.
Time and topics
1:41 -- What is cannabinoid hyperemesis syndrome?
2:53 -- Symptoms are often relieved by hot water baths or showers
04:30 -- The first report of cannabinoid hyperemesis syndrome was published in 2004
05:45 -- Cannabinoid hyperemesis syndrome might have been around longer, but not recognized
06:29 -- Cannabinoid hyperemesis syndrome might be the result of stronger cannabis being easier to get and use regularly
07:12 -- Why has CHS not more widely known?
08:41 -- It’s not profitable to publicize CHS
10:48 -- Why don’t cannabis companies warn consumers?
14:00 -- Cannabis prohibition was a bad policy
15:16 -- State governments are mostly silent about CHS
18:40 -- Knowing about risks is important for consumers to make informed decisions
22:29 -- Is CHS dangerous? What are the possible complications of CHS?
26:26 -- How often and for how long before cannabis use poses a risk of CHS?
28:49 -- Treatments for the active phase symptoms of CHS
31:55 -- The definitive treatment for CHS
33:51 -- What to do if you think you might have CHS
34:59 -- The leading theory about what causes CHS
36:51 -- Tips for stopping cannabis use
Notable quotes
“If you don’t know that something exists, it’s hard to see it.”
“This could be a newly-recognized fallout from greater access to higher strength, longer-term use of cannabinoids.”
“There can be extremely important medical information that gets published, that probably everybody ought to know about. But there’s just not a mechanism to disseminate the kind of information to people… Absent funding to disseminate knowledge at scale, knowledge dissemination happens at a trickle”
“Because of prohibition, we know relatively little scientifically about marijuana’s risk profile. Through prohibition policies, you’ve made cannabis way popular. And through prohibition policies, you’ve made its safety profile a subject of debate”
“States, in my view, have done a good thing by trying to make a substance available that might help people… But the idea of having a state government endorse marijuana as a medicine, display medical benefits on their website, and not say one word about risks is irresponsible”
“You’re not supposed to feel nauseated. You’re not supposed to have unexplained appetite loss. And you’re certainly not supposed to be vomiting a lot. So, if you have any of those things, do get checked out.”
“It can become very confusing. How can something that is supposed to help with vomiting cause vomiting? The answer is because the body develops tolerance, and the body wants to kind of fight back against whatever the drugs are making it do. So, if you take a drug constantly, which turns down the vomiting response, the parts of your brain that regulate vomiting, are actively pushing back against the action of the drug. In chronic suppression of the vomiting system, the vomiting system like builds muscle and gets stronger.”
“You might be one of these people for whom the body has just revved up its vomiting machinery. The only way to get back to normal is to put a pause to cannabis use and let the body’s vomiting machinery get unwound back to its normal state.”
“Recovery is not a solo sport. Recovery is a team effort. So, if you put a pause on cannabis and your stomach is feeling better, then do get friends, get family, get new friends, find online support groups, find a new team, or enhance your current team to help you to support you, so that you can try to figure out other things to do what cannabis used to be doing for you.”
“A whole lot of people who are in recovery have been where you're at. And they will lend you some confidence and probably all sorts of love and support in trying to help you to get to a better quality of life.”
“Nobody wants you to stop weed and suffer. Everybody wants you to stop weed and to have, you know. a more awesome life as a result.”
About the Host:
Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He’s a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.
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