Weight Challenges with Mental Health Treatments: Insights from Psychiatrist Dr. Mark Novitsky

While psychiatric medications can be essential for improving mental health, they often come with unwanted side effects, including weight gain. Historically, a lack of integration between psychiatrists and other healthcare providers has meant that the impact of these medications on weight has often been overlooked.

Today, I’m excited to bring Dr. Mark Novitsky (husband of Dr. Ali Novitsky!) into the conversation, who is board-certified in child and adolescent psychiatry, adult psychiatry, and obesity medicine. Dr. Novitsky emphasizes a therapy-first approach and promotes healthy lifestyle choices for his patients, addressing issues like ADHD, anxiety, and depression through holistic strategies that include sleep habits, exercise, and nutrition.

In this episode, we'll be exploring the relationship between psychiatric medications and weight gain, common medications that may influence weight changes, the role of genetic testing in personalized treatment, and practical strategies for managing weight concerns associated with ADHD and psychiatric medications.

References

Novitsky MD Boutique Mind Doctors

The Fit Collective™

The 31 Days of Fit Program

Optimizing GLP-1 Weight Loss for High-Performing Women

Audio Stamps

01:13 - We hear about Dr. Mark Novitsky’s background and how he helps people.

09:44 - Dr. Novitsky shares some common antidepressant and antipsychotic medications that can cause weight gain due to increased appetite.

15:58 - Dr. Novitsky introduces the three pillars of health and digs into why exercise is crucial for overall mental and physical health.

19:35 - We discover strategies for improving sleep hygiene, which is key for improving your mental and physical well-being.

29:43 - Dr. Novitsky discusses how ADD and ADHD can impact someone’s relationship with food.

Quotes

“There are certain medications that we know of as practitioners that are going to result in more weight gain.” - Dr. Mark Novitsky

“The ones that tend to fix things quickest, the atypical antipsychotics, tend to cause some weight gain. The problem is, if I'm doing my job and fixing someone quickly in terms of the psych meds, then it might actually be pushing them in the wrong direction.” - Dr. Mark Novitsky

“Sometimes the path that isn't the quickest is the best.” - Matthea Rentea MD

“We can actually see a lot of the genes that are going to determine what type of emotional eating pattern people are going to follow.” - Matthea Rentea MD

“If you're not sleeping well, you don't want to go down that road of getting one of these other heavier duty sleep meds thrown your way because it's going to increase the appetite.” - Dr. Mark Novitsky

“You should be the captain of your team in terms of your mental health treatment and your obesity medicine treatment.” - Dr. Mark Novitsky

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

Transcript

0:28

Welcome everybody. This is a really exciting day because I have wanted to do this for so long to bring Dr. Mark Novitsky on. He is actually the husband of Dr. Allie Novitsky, who I work with, but here's the really nice thing. So he's a psychiatrist. He has such a deep understanding of these medications of the intersection with mental health of all of it. And I want to have those conversations. They actually had the privilege of, meeting Dr. Nowitzki when I went to Ali's conference and I actually got to talk to you some, which was so exciting. The other thing I want to bring this up, you're also American Board of Obesity Medicine board certified, which is so exciting because I feel like you really understand all of the aspects. And so can we start out with you just introducing yourselves, tell us a little bit about, about kind of how you help people just so we have a little bit of background. Sure thing. Well, it's so great to see you. You know, the last time you and I were chatting, I was studying for that board exam and you were giving me a couple pearls and your advice helped. So thank you. It's so exciting to be joining the ranks here. And I just got to say, I am a fan boy. I love everything you're putting out there on social media. I mean, I, I did not get on to tick tock until late in the game, but when I did, I, I, I'm just loving all the content you're putting out there. Thank you. So one of the things that really draws me to you is the authenticity and, the vulnerability and as a psychiatrist, those are things that we, we value. And so, I am a practicing psychiatrist. I'm board certified in child adolescent, as well as adult psychiatry and now obesity medicine. And I have a practice right down the street from home, and I see patients, adults, as well as children. We're located in Pennsylvania. And, it's a matter of, for years, psychiatry, you know, there was that stigma, right? Right. And To the credit of society, people like Tay Tay, you know, coming out and talking about the importance of her therapist the stigma seems to have lessened over the recent years. I mean, obviously still there, but As psychiatrists, and this is something you and I were talking about prior to jumping on for years, psychiatrists have kind of been in this silo where we've been practicing on our own. There hasn't been as much of an integration. With the, the PCPs and, some of the other docs. And because of that, I do think that patient care has suffered, because a lot of the psychiatry meds, while being super important and life sustaining in many, in many ways, there are negative side effects that can come from some of the medications. Now, With that, I think what psychiatry needs to do is to understand the impact that some of these medicines can have with regard to weight gain. Yeah, yeah. Oh, you brought that up so nicely because that's actually one of the main things I wanted to I have a few things I wanted to talk to you today about, but I wanted to have this conversation. So let's say that You see someone in clinic, you know that there is very much so a need at that point, they've gotten to a point where they need a medicine. What do you kind of think through with people because we know that a lot of them can cause weight gain. And so what's the thought process when you're picking something or, you know, or kind of going through that with people. So I think the key is when I'm doing that initial evaluation is really getting a sense of the person and what their goals are. So safety first. Yes. No question. If it's a matter of life and death, and we need to choose an agent that's going to work really quickly. That's one thing, but more often someone comes to me pretty stable and just looking to optimize things in their world. Maybe there's depression or, you know, some history of bipolar too, and we're looking for different solutions. And it's a matter of giving that menu to really enabling the patient. From day one to have a choice. I want things happening through them, not to them. So they need to, they need to, you know, number one, take some ownership in the path that we're putting out there. I'm riding shotgun and giving some directions, but I ultimately want to empower them to have a voice. And with that, there are certain medications that we know of. As practitioners that are going to result in more weight gain. So if I see that somebody is overweight, and as we're talking about, they're doing this bio psychosocial evaluation that they've been bullied for, their weight as a child and I hear them using some of the labeling, some of the cognitive distortions of, you know, well, I, I've failed diet several times and I'm just, I can't, I, Know that that is part of the battle. You know, you want to help them feel good to optimize how they're doing. We need to be aware of those things. So choosing an agent, that's going to be the quick fix that might result in weight gain. I'm not going to go down that road. I'm going to acknowledge. It sounds like you're saying that this is also part of your goal option. B, C, and D would result in less weight gain and being able to have that conversation and letting them choose. Yeah, yeah, that's so good when you bring that up because I feel like a lot of people, they want to feel better. But at the same time, like you said, if you knew that history, it's going to be so much more distressing if they then have to deal with weight gain. That was something when I was in primary care, you know, a lot of it's mental health, right, like depression, anxiety, kind of stuff like that for bipolar and things like that, I would Make sure to refer on. But I remember my first goal would always be that they don't have sexual side effects, that they don't gain weight. Like these were important things depending on the priority of the patient in front of me. And that was often the first thing they would ask about. They would come in for depression, anxiety, but they would say that this is what I don't want to happen. Right. So they knew enough to even bring that up. So is this something that, I mean, I, I, I wonder whether all psychiatrists are having this conversation because I also kind of saw the opposite where people would gain a lot of weight. They wouldn't realize, you know, like they knew that the medication had caused it, but I don't feel like they even knew that that could happen. And so I'm wondering, is it becoming more common in psychiatry to use the anti obesity medications? in tandem? Like, let's say if you know you have to start an anti psychotic to say, hey, we could predict this weight gain. We would start. I mean, like, is that being used more commonly? I think it is still kind of cutting edge and the, the GLP ones, we can get into that. But I think that that's a lot of exciting territory and it's going to help psychiatry. I think the problem for so long again, is psychiatry was like, let's fix. this depression. Let's, you know, the, there's been such a push for the scales. Let's improve the scales as quickly as possible. And the problem is the ones that tend to fix things quickest, are the atypical antipsychotics, which are Most people actually think that those are the depression meds. I say, hey doc, I want to try that new depression med, Rexulti or Vraylar. Meanwhile, they are atypical antipsychotics, which are great. Don't get me wrong. They work very quickly. We're going to see results quickly. You know, obviously everything is individualized. But those tend to cause some weight gain. The Abilify's of the world, they tend to cause some weight gain. So, the problem is, if I'm doing my job and fixing someone quickly in terms of the psych meds, then it might actually be pushing them in the wrong direction. So, for certain people, if I see a bipolar 2, Maybe we're talking about a lamictal lamotrigine, which is going to be more weight neutral. And it is a process. It's going to take two, three months to get to that optimal dose. But if somebody, I want to give an individual that choice. rather than pushing them in that direction. Yeah. You know, you hit on a good thing. And I, I always, I'm always thinking about like, where does this show up in my practice? And I think you hit this on the nail where it's sometimes the path that isn't the quickest is the best, right? Cause I think about sometimes, everyone's always obsessed with injection, GLP one options, things like that. But I think we do actually have a lot of oral options that do a good job that do things, but it might take sort of a quote unquote loading period, right? Like you might, for however many weeks need to up titrate the dose or, you know, there's certain things we need to do to figure out to kind of get it to the right place. But I think that in the long run, they might be able to stay on that because they can afford it and they're going to get the results that they want, but it won't be month one, two, three. And so it's like realizing, I think if the clinician is skilled, you can help tell the person this, and then they can get on board because they're not expecting to have a certain result right in the beginning, right? So that kind of, that helps. Can you tell me, like, I feel like a lot of the, can we say a few names, for example, like that are, let's say common depression meds that might lead to weight gain that people wouldn't think of? Like, are there a few where you kind of commonly see weight gain? Sure thing. Yeah. So I mean, the biggest culprits are the Seroquels of the world. Quetiapine is the generic. More often than not, that is used for sleep. Things that make us sleep, hit the histamine receptors in our brain, but we also have histamine receptors in the GI tract. And so when that Seroquel is hitting that histamine receptor in the GI tract, it gives you the Seroquel munchies late night. And so I have people who are saying, you know, doc, that meds working wonders for my sleep. I'm finally sleeping through the night. But man, I'd wake up and I'm starving in the middle of the night. So that's, you know, those meds, the, that's in that class of atypical antipsychotics, Abilify or Epiprozole, Risperidone, Risperdal are other ones. Interestingly, as a child and adolescent psychiatrist, those last two, the Abilify and the Risperdal, Those are the only medications that are FDA approved for kids with autism. So with autism rates going up, the prescription rates for kids who have, you know, difficulty with expressing those emotions and the irritability associated with that. Those are the medications and we see those side effects that it's affecting kids and, you know, the childhood obesity rates. So, I think we need to be aware of the pros and cons with that. There are the SSRI antidepressants and, you know, things like Zoloft. Tried and true, wonderful medication, right? But, all of those can increase the appetite as well. So, I do want to reiterate something you said before, that, you know, if somebody needs one of these medications, it is, It's vital, you know, we're talking a long term, battle in terms of depression, anxiety, maybe, but as well as the obesity and overweight and the increased hunger. So I think If you are in a state where you need one of these antidepressants and that's what your psychiatrist or family doctor is recommending, then go for it. You can always voice the concern and say, Hey, I'd like to, I'd like to consider one of these other options is Fluoxetine, Prozac, an option instead, which might be a little bit less or if it's just, depression you might ask for something like a Welbutrin, Bupropion, which tends to, if anything, decrease the appetite slightly, more weight neutral. No sexual side effects with that, but not all that great for the anxiety piece. In my practice, I actually like to use genetic testing. Yeah. So I do the genetic testing pretty much routinely. It's not going to allow for, you know, the chosen medication to rise from the mist, but it does allow for us to at least have a roadmap, to eliminate some of the trial and error. So we would see if, you know, certain options are going to be better than others. It looks at. many different genes like SLC6A4, which says big picture, wouldn't SSRI work or not? So it avoids that whole, you know, six months down the line. Oops, I guess this isn't the right medication for you. Let's try another one. This is what I experienced in primary care. So I actually started to incorporate the test as well. It was interesting. I was able to use it for years. And then they suddenly said, Oh, only a psychiatrist doing it. Are we going to cover that test? Right. They're very expensive tests otherwise. And, but what I would see, so I would have gone through months of trial and error, right? Like you said, we would, we would titrate up not okay. Does not work six months and we try something else. You know, so we were going through all these things and then I would get the test back and I'm like, everything that didn't work was right in that column. And I'm like, well, That would have been really helpful. So it's interesting that you bring that up. And it's interesting because in obesity medicine, I'm sure you see this too, because I think a lot of the tests are the same ones that we're using. We can actually see a lot of the genes that are going to determine what type of emotional eating pattern people are going to follow. Now, you don't, in my field, we don't have to do these tests because you almost telling me I can, I know what's going on. But sometimes it's from just a, I say from a morbid curiosity standpoint, at least for me, I got it. Then I was like, answers a lot just explains a lot. Right. And it validates for the patient, right? It's not a me problem. This is how I was born. I have. Genetic, barriers that make it tougher for me versus my girlfriend who can eat whatever she wants when she goes out and yeah. You know, why is life easier over there? So yeah, things you're referring to the five HT two C, the mc, four R, those genes definitely. But even that SLC six A four, I was looking at. When I see the short alleles, for example, somebody who has a short short, there is a higher cortisol release in response to stress for these individuals. So when it rains, it pours. I, it helps me to reiterate the importance of therapy. I'm very much a therapy first psychiatrist. You, you've got to have those skills. The whole purpose of medication. is to get you in a space where you can utilize the tools that therapy brings. But, you know, for that, when somebody's stressed, it allows me to say, hey, listen, you are going to need a little bit more time to settle down before you Try to talk things out if you're upset with your partner, and understanding that that might be the time where there's a tendency to want to self medicate through food, perhaps. So being one step ahead of things and knowing your genetics are going to set you up for that. But cortisol, you know, cortisol is going to increase. The hunger and, lead to weight gain and that's where, you know, stress can come in. And I always in my intake start by talking about those three pillars of health, the, the need for adequate exercise. Sleep and nutrition and people were like, I'm coming to see a psychiatrist. I know. Why are you talking about this? But every gimme the meds. Right. Exactly. Right. I'm sure you get that. Like, enough is enough. Yeah. They're like's my g ones' doing me. I'm like, wait, we need all of this. So, sorry. Keep going. Yep. But I, I mean it, that's exactly it. Right? So for obesity medicine, those are the keys. I mean, exercise is so critical, especially as we're talking about. Get number one, getting your steps in, but that strength based exercise was, which I know you and Allie have talked about so many times. And, Allie being my wife who, does the, strength based exercises and fit collective. We'll, we'll talk about that a little bit later, but that in terms of the mental health. Exercise also has huge benefits, you know, and we'll get into ADHD in a little bit, but for so long people thought like, Oh, let's just get, make sure they get their energy out. But exercise, exercise does so much more than that because certain individuals, when we do the swab and we see the BDNF, the brain derived neurotrophic factor, BDNF is like, how good is the soil up in the brain? And, some individuals are naturally born with the tropical rain forest where it's optimal and, more BDNF allows, if you go back to high school science and you think about what the nerve looks like, those branches upon branches, that's the BDNF. When you don't have enough BDNF, it ends up in there being less communication between the nerves. So that can impact. If we're talking focus, if you're like my, you know, when I don't exercise, my mind is just kind of mush, certain individuals with the met variant really need exercise to be able to focus, to be able to, if we're talking about mood. For nerve one to communicate with nerve two, the closer they are, the more secure that message is the serotonin getting from point A to point B to allow somebody to feel good. So this is part of it. I can talk about medication, but for the meds to work optimally, we need to make sure that we are exercising to allow us to keep the dose at the lowest possible dose. Oh, that's so good. It's so good. I know. I feel, I feel radically different with movement. It's very fascinating. I almost, I wonder, I wonder how quickly the BDNF levels change, right? But I, for me, I find with walking, like I've got to exceed that 35 to 40 minute. And then suddenly there's this, I can literally feel this, the stress or whatever my body's experiencing. It goes from a 10 to a two, like I can feel it. That's the drop off point. It's not before that. And there's just something magical that happens. And so it's very interesting when you're talking about that. To me, I have found that if I don't move daily, I, I'm irritated, I'm snappy, everything feels too much. You know, it's just very fascinating how much that simple practice of just doing something with my body What it, what it kind of leads to. So I love that you brought that up as pillar number two. How do you work on sleep with people? Cause I feel like everyone's got this as a problem. Oh, it is such a problem. Well, it really starts with sleep hygiene, right? Which sounds like, okay, here it goes again. I know, I know, but starting with little steps. So number one, if you have a clock that's staring at you. Maybe you turn that clock around. Maybe you just decide a time that you'd like to wake up and a time that you want to go to bed. They say that, really standardizing the time that you wake up is the best way to get the circadian rhythms, on track, but access to your phone. Is the biggest, biggest issue, right? Guilty. Guilty. I know. I've been there, done that but you, you just have to decide a time because if you're on there and, you know, if, if I go on late night and I'm watching your latest videos, I'm going to be stuck. It is, it is so addictive, right? And you're learning so much and the brain is like, this is exciting. This is interesting. But there needs to be a time. that it's going off. There are some life hacks that you can do. If you maybe say the, the hour before bed, if you're listening to relaxing music, this is not the time to be, you know, listening to your pump up jams, relaxing music. Maybe you take a nice hot shower or bath. That is Allie's go to every night. It's her way of resetting and de escalating, chamomile tea, but the shower, it actually tricks your body when you get out from a hot shower, tricks your body into feeling like, it's, it changes the temperature regulation a little bit. So when you go to bed, then you're going to be better able to go to bed. And so just being more mindful about it. Those are some of, some of my recommendations and the more you do it, sometimes it's hard if your partner is not, but you know, I, we also, in our house, we listened to relaxing rain sounds, good old Alexa, every night. So just having a bit of a routine is, would be my first go to. And then obviously if you have a therapist or a coach that you're working with, having that communication about what's working and what's not. Yeah. It's always fascinating to me. Like for me, I got to this age where I just couldn't do caffeine. I never was big into caffeine, but like, I can't do caffeine afternoon timeframe. Exactly. Yeah, you're holding up. I've got my coffee here. So what I, but it was so interesting, but it wasn't only that. It was stress level. I had to look at everything and I had to put like, we're going to end work by this time. There's no getting back to the patient after 8 PM, like period. I don't care what it is. If it's that much of an emergency, they need to go to the ER. Like I had to start to Put these things in place because I needed, like you said, all this wind down time, for my brain to just kind of accept that night time is coming. And then I realized that wasn't abnormal. That's actually quite normal. I don't think as cavemen, they were on their iPad scrolling at night, right? We still have the same brain. I love that you bring this up. And I probably out of everything, I am the most intense about getting my sleep. I go to sleep at the same time. I wake up at the same time. I don't even want to get up at the time I'm getting up, but my body's just like, this is happening because we've done it for so long. I know this can be a struggle. And so I want to say, if you're listening out there and you have a hard time with sleep, please talk to your doctor because we're making it sound easy right now. It is not, we don't want to minimize like, I know so many people struggle with this, or maybe it's just who's seeing me, but this is a really big area that I think people like the health would be exponential to them as far as their health, if the sleep was better. No question. And we talked about if you're not sleeping well, you don't want to go down that road of getting one of these other heavier duty sleep meds thrown your way because it's going to increase the appetite. Right. It's a double edged sword though, because if you're not sleeping well or, or, or enemy Grelin comes into the mix and is causing us to be hungrier. Yeah. I always tell, you know, I know we're gonna get to your third thing here, but I always say when patients come into my clinic, I'm like, I want you to imagine a pyramid. And at the, like, what's the most important at the top, right? So let's say if I was in primary care, I would have said stopping tobacco use. That would have been my, like, that overweight loss for anything, right? But in my world, at my pyramid at the top is sleep. And I'm like, sleep is going to come before any nutrition change, any of these other things, because I know they can play into it, but if you're up multiple times a night or there's something happening in life, we've got to kind of work on that before I can bring it even more for you to do it. It's just like a hard challenge. Yeah. I mean, in training, I go back to those days where we were doing our 24 to 30 hour shifts, right. And when we were on call at night, because of staying up all night, I would eat well all week and then I found myself ordering the worst takeout Chinese fried you name it because the self control just wasn't there and the ghrelin was was creeping up. Yeah I remember that yeah my equivalent was the and I will never again in my life eat these but but what brand is it schmuckers or whatever they have these peanut butter and jelly these My goodness the ones that are in the freezer and then And they're like just oozing with like jelly and peanut butter and it's like white bread, the sugar, ultra processed. Yes. I never again can have one in my lifetime. Like we've never brought it in the house. Cause I'm just like, I can't relive this ever again was going to say that goes right into the nutrition piece, right? Because That's the body at that time when we're up late the Speaking of the cave person brain is still like this. We shouldn't be up right now Why are we up something must be wrong? And so we get a little bit of that dopamine the ghrelin we are feeling like this must be some sort of thing Fighter flight, and something's off. We get hungrier. We feel the need to nourish ourselves. And in the case that something's wrong. So we are looking for these ultra processed, you know, you're, you're not craving a salad late night. No, no, never. So those smucker's crustables, that's, that's, that's what the body wants late night, right? And then the problem with that is the more we feed into those ultra processed, the, we talk about the mind gut connection, the microbiome, You know, we have a certain bacteria in our GI tract that really likes the processed foods, and we want to have a nice variety of that micro microbiome. But when we start to favor those ultra processed foods, we have a growth. Of the bacteria that likes those ultra processed foods. So we start craving more ultra processed foods and it gets to be this vicious circle. Yeah, it's quite intense. I, I, so over years, I really had to work to bring down processed foods. And it's fascinating to me. We just celebrated Easter here this past weekend. And a lot of my plate was great, right? Like there was broccoli and cucumber salad and I'm hard boiled eggs. I'm a vegetarian. Okay. Like all this great stuff. But then for dessert, I had some fruit salad and my sister made these carrot cupcakes and it was all great ingredients, right? Like, I mean, anyway, in the grand scheme of things, I was like, yeah, I'm still hungry. I want to eat this. And then the days after it was incredible to me, my hunger levels, how much, like, I don't know that. Yeah. It's at multiple levels physiologically, what's getting driven there, but it's fascinating. I think once you really bring down these things, what they do to you, when you eat them, you suddenly realize, wow, I was always subsisting on that and didn't realize that if you're someone that has my history, where you were like doing that all the time before. Right. Yeah. It's fascinating. Right. And then people blame themselves. They think it's like, no, it's just like, when you have it, it makes it worse. Well, and I think it's important to have that perspective, right. Because All too often in the past And it, it was not an easy process for me either because I, I grew up doing every single fad diet, you know, tried zone and tried Atkins, you name it, it was, and, and then when I met Allie, it was like, let's try this together, you know, but I used to kind of reward myself. There was a time where there was that splurge day. Where all week we would eat well and then splurge day, eat whatever we want. And it was a shame because we rewarded ourselves with eating like that. And then, but what I'm hearing from you is that you're able to have that perspective, that it is beyond the taste. I'm sure there's carrot. Cupcakes, they sound delicious, but beyond the taste, when you see something now being able to say, well, do I really want to feel like that? The next day, having something to counteract the craving. Totally. Totally. And it's nice when you have the perspective of like, this isn't a willpower problem. It was a very conscious decision to have it, but you know, for me, I know it's going to be two days of having to calm that down. And I'm like, okay, so on Easter, I'll do it. But the rest of the time I'm like, I don't want to have to deal with it. It's really not worth it to be honest. Plus I have tons of other things. Like I'm having things all day long that tastes great, but I just realized like, there's something about flour and sugar. There's some certain combinations for me that just don't, don't work well long term for me. Yep. No, I made a conscious decision yesterday to just go for it, enjoy it, and I too am paying the price today. So these are okay. These are three really good points of just realizing how important exercise, sleep and nutrition, how it's really, it's so interesting. This is actually totally, I have like certain metabolic pillars, these are them, right? And then add medication in there. Right. I mean, this is all of it. So let me ask you to kind of switch gears slightly. I feel really, an area that I don't hear talked enough about is ADD and ADHD and kind of how that affects either the relationship with food or what life might look like with that. And I'm wondering if, I mean, actually half my patients in my clinic have that. So either that, or they've had a history with bariatric surgery. And I'm wondering, And I see certain patterns, and again, I'm always cognizant of maybe I'm attracting certain people because my work tends to not be just here's the medication and goodbye. I really want to work through these things, right? So can you tell me, do you see any, any, can you give us a little bit of background with ADD or ADHD? Kind of how has the brain, Processing things, and then how might that affect food or kind of what do you, or habits, what do you see in that area? Yeah, no, definitely. So A-D-D-A-D-H-D, what we're really seeing here, the, the thought is that we're not getting enough Dopamine. Dopamine is that chemical that says, Hey, pay attention. This is important. We're not getting enough dopamine from point A to point B. Up in the command center of the brain, the area that executive functioning is occurring in that prefrontal frontal lobe. And when we don't get enough dopamine, that signal of pay attention, this is important, you know, that signal isn't getting there. And instead it's, oh, look, a bird, and we're getting distracted by something else. So it can lead to three major issues. Number one, inattention. So, this is, you know, the classic inattentive kid sitting in the classroom dozing off, or, you know, if you're in a board meeting and somebody's rambling on, you're thinking about something way off, there can be hyperactivity, which, by the time we're adults, tends to wear off for many people. The impulsivity still can be there and that is key for the eating. So impulsivity, really not thinking through the consequences, you know, we talk about willpower and this is why we'll trying to lose weight based on willpower alone really does not work because so many people, that willpower, the impulsivity is affecting them. But when we're hungry, The willpower is even less, right? So, but this is where ADHD can worsen the ability to hold back from certain behaviors. And we do get a little hit of dopamine when we choose our favorite go to snack. So that's, that's probably part of it. You know, an interesting thing about ADHD though, is the medications, the stimulants are more effective in head to head studies than the non stimulants. So things like Adderall, Vyvanse, Dexedrine, the methylphenidates like Ritalin, Concerta. Those, or Focalin, those medications, they work by increasing the amount of dopamine and norepinephrine available in the brain, which is helping that signal get from point A to point B, and allows for better attention, decreased impulsivity. When the meds are in the system, It actually will decrease the appetite many times. So to the point where a lot of the smaller kids that I'm working with these, you know, I have to explain to the parents how important it is to eat in the morning because lunchtime, they might not even touch their food. And at that point, I'm just looking for any old snack to get in their system so that they're able to eat enough so that there's glucose going to the brain by the end of the day. And then advising that once the med wears off, we're going to see a rebound in the appetite. And if you think about that, if somebody is doing that for years, the body gets used to, I'm not hungry. I'm boom, a big appetite in the afternoon in the evenings. And if that process continues for adults, it's kind of years of setting up this, the system where we're eating a lot at night, which as you know, can then lead to excessive weight gain. Yeah, that's, I love that you brought that pattern up because it's interesting. I wonder, so is there data to suggest like if people long, like let's say an adult, because I see mainly adults. So I just want to talk about that for a second, but let's say that they're long term on a stimulant based treatment. Does their weight set point significantly come down? Because I hear with my patients that it helps initially, but then they, it's not, it's not super significant No, so it helps initially, right? But then There comes a point where it levels off. Yes, okay, because I don't see it very much. So that's why when people think, oh, if I was just on that, it's like, no. This is for treating that, but not weight, right? So it's just, it just doesn't work long term. It seems like people have figured out how to balance and they compensate by eating later. Yes. Yeah, definitely. That's a good talk. So do you have any strategies for patients that struggle with this that maybe are also struggling with their weight? Do you have any common things that you see with patients or what you recommend to them? Yeah, I think the key though, really is, and you as a provider, I know things are very individualized. So being able to, to look at the meals and when are they happening? What everyone has their their own little battle. So is it a matter of we're eating too late? Because of that is that affecting the sleep and we're up and not able to fall asleep because we just ate a big meal later So I think having an idea, we talk a lot about journaling feelings, journaling these behaviors, right? So that's part of it. Understanding when is the med wearing off, right? So the concertos of the world, the Adderall extended releases those work about eight to 10 hours, something like a Vyvanse we're looking 10 to 12 hours. So if we take it at. 7 a. m. You know, maybe by 5 p. m. to 7 p. m. the meds starting to wear off frequently, even sooner, in clinical practice. So in those evening hours, there are side effects from medications, right? So sometimes we see a little bit of irritability, a little bit of a comedown. If any of us were binge watching our favorite Netflix show for 10 straight hours and we have all this dopamine used up in that period of time. I don't know about you, but I've, I've binged watched on a Saturday or two where, when I finally get my own time and I stand up after all that time and my brain is mush and you know, at that point I'm going to give in, I have very little, ability to say, nah, I don't want that snack. No, I don't want to order pizza right now. So understanding that we might be up against more when the Met is wearing off. So there are boosters. Of course, you want to make sure something's going to be able to wear off by bedtime, and maybe you don't need that. That's when exercise is so critical. So be, to be able to do something active that's building up some of those natural endorphins, and resetting things so that your body can feel good. You're building up more of the dopamine, you're getting that, that BDNF surge, and you're going to be able to make better decisions. Yeah. Oh, you said a lot of really good things and I wanted to highlight a few of these because I'm like everyone who's listening, a million things just got said. Okay. So number one, when you were talking about journaling the behavior, I was like, that's very interesting because I find the awareness goes up, right? They've got to know, okay, I've got no hunger here. I've got hunger there. The biggest thing I see when people do that, because I'll like, there's actually a journal that's part of our clinic, right? It's like a 90 day thing. I love it. I'm like, I love it. I'm a journal girl. I'm like, you're going to get one, but the point is what I see, you mentioned timing. And then I thought timing of meals, hydration. So what we'll be able to pinpoint usually is like, they're not cluing in until, I don't know, I'm going to take a random example, right? After 4 PM, they're like, shoot. Yeah. Didn't get any liquids in today. I tend to go to the bathroom, didn't eat. It's like, good to know. Good to know. Now if you're not hungry, maybe we're not going to have a ton earlier in the day, but like we can start to work toward a little bit shifting the patterns, right? So I love that you brought that up. And I always say to people, it doesn't need to be intense, right? Do you tell people, just take a sheet of paper, like, shred it after you don't, it's not about looking back at it, right? Everyone thinks it's, like, imposterity, I'm gonna hold on to this. Like, no, we're just trying to, we're trying to have some pattern recognition, like, what's, like, when these things are happening. Yep, no question. I say just put it in the note section of your phone because, you know, you're not putting that phone down. You can't even go to bed without it. Like use it for good. No, probably I used to reverse chronologically document stuff, so I didn't even have to like go to the bottom of the note. So I love that you brought that up. And then the other thing is, yeah, just having an understanding of, if you're needing a med again, that's great. A lot of people, I know in my family, we have someone on one and they're amazing on it. It's like, they're a different person and it's incredible how effective these medications can be. And just learning when does it wear off? What's that going to look like as far as kind of how you're feeling? Maybe that's actually really not a problem. Again, nothing has gone wrong. Just sort of learning all of that. normalizes it versus every day this happens and this is the end of the world, and unless, like you said, there's going to be a med change or something. That's going to be done. Maybe we need to normalize that a little in the name of you getting 10 good hours, like maybe you had zero productive hours or hours that were worth anything, right? 100%. And again, all about having that communication with the families. Is it a medicine for the stimulants? They don't necessarily need to be taken every day. So there's that issue of med holidays. So many of the families, if they have concerns about eating or appetite. on the weekends might take a med break. Maybe if there's homework, they only take the short acting booster for a certain number of hours and really having control over the medication. And I think again, the, the key, much like, the goal with treatment in the obesity medicine world is we're not going to label ourselves as, Oh, I've got ADHD. It's, a matter of I'm going to control the symptoms, but ultimately it's me saying, you know what today I am going to want to eat a little bit more and we're just going to take the short acting because I Don't need to focus. I don't have any major plans, but having that communication With your physician in terms of what's important for you Yeah, yeah, office. These are such good conversations. Thank you for coming on. Do you think there are things that we didn't talk about today? Anything that's really important that we still that you think people need to hear? No, I really think, you know, the key obviously is if you have any concerns, as you always say, this is not medical advice. So you should reach out to a professional. If you have any concerns, talk to your doctor, you are the consumer. I've had people who come in and say, my doctor said, I need to do this, this, and this, and. Just reach out if, if you do have questions, we are in the day and age where there's a lot of great information online, ask your doctors about what you're reading, what you've heard on Dr. Matea's podcast, and, you know, just bring these up because you should be the captain of your team in terms of your mental health treatment. Your obesity medicine treatment. Yeah, I really love that you bring that up to talk about things. I can't tell you how often there'll be like articles out there. And that's something I'll bring up in my clinic. Like we do like, you know, Q and A calls and stuff. And it's, it's always this thing got brought up, but is it true? Is it not? Let's actually talk about it. Right. So I think that's a great strategy, right? Like Bring these things up. Yes. Hey, everybody sees the study. Bring it up with your doctor. I'm sure they've seen it too, or if not, they'll be happy to take a look at it and give you their thoughts. So I love that you bring that up. Actually work with a professional. I think there's too much happening right now where people are on social and they're like, Oh, this happened with that med for that person. So that means it's going to happen to me. It's like, Well, we all have different physiology, different genetics, you just can't do that. Like, everyone's gonna have a different experience. And maybe your doctor could have a little bit of a predictive ability of what you might experience versus someone else, right? Like just knowing you a little bit. That's well said. So tell us, how can people find you? Tell us a little bit about just kind of all the ways that people. Kind of if they want you or exercise kind of things like that. Tell us a little bit. Yeah, sure. Thanks. So if you are in Pennsylvania and, we're actually right across the border from Maryland, Maryland and Delaware. So we are out in Chad's Ford, Pennsylvania. And the practice is called NovitskyMD Boutique Mind Doctors. And so NovitskyMD. com is your source for if you have a loved one, who's looking for any mental health treatment. We have therapists, we have, a behavioral, a child and adolescent, behavioral pediatrician. Developmental pediatrician, I should say, as well as an adult psychiatrist, nurse practitioner. So we got the full team, and we do tend to think outside of the box. You know, obviously safety first, but if you're looking for more of a integrative approach. Come find us, ask us some questions. In terms of the exercise piece, my, my second life is with thefitcollective. com. So the listeners may remember Ali Novitsky, And she is the expert on, strength training and, obesity medicine certified. And she has the program, the fit collective, where she helps, she started helping, Women physicians and now she's about to release a program for women physicians and GLP ones and women professionals with GLP ones. But stay tuned because I'm going to be taking a larger part in the company. Right now I'm editing the podcast and doing the behind the scenes work. But now as a board certified psychiatrist, and there are not too many of us out there, really bringing the, the mental piece. Something that I've used myself of LA's programs is the 31 days of fit. And I would encourage any listener who's like, you know what? I really do think that I need to, to get back into exercise. That 31 days of fit truly changed my world. 11 minutes a day of exercise plus one. Minute of motivation. What's incredible is she's super sets the exercises so that in that 11 minutes, you're actually getting a really good workout in, and she's doing mindset coaching at the same time. So being able to get all of that, I think, you know, especially if we're talking ADHD and it's the afternoon and things are wearing off in less than 15 minutes, you can get a quick refresher. Yeah. Okay. Listen, this was so great. We're going to link everything down below your clinic information, the different programs that you're talking about. I want to say real quick with the 31 days of fit, I did it in December. Phenomenal. It's actually super challenging. Like no matter what level you're at. And I've actually had a lot of patients that have gone through it. Some that themselves even have trainers or I've worked out for years and years. And they're like, They're like, listen, Dr. Rentea, that was, she's got some wounds in there. I was like, what'd you think I was going to give you? Something that didn't work. Yeah, you think 11 minutes, but I leave there sore and you want good sleep. You're going to sleep well after those. Exactly. Thank you so much for coming on. I, I've learned. Thank you so much talking to you today. I'm sure everyone's going to love this. We're going to again, make sure to link everything and I'm super excited to see you more in these programs because I just love the way in which you talk about stuff. I feel you have such a nice understanding of all of it and people are going to benefit so much from that. So I'm really excited to, to hear you more in there as well. Oh, thanks so much.