Psych Meds: Yearbook Edition

Summary
Psychiatric meds but make it a high school yearbook superlative. 🏆 In this episode of Brain Trash, Maria and Tabitha dive into the chaotic world of mental health medications—who’s the MVP, who’s most likely to ruin your sex life, and who’s the overachiever you can’t live without. From SSRIs and benzodiazepines to ADHD meds, we’re breaking down what they do, their side effects, and the real conversations doctors aren’t always having. Plus, let’s talk about what no one wants to admit—meds affect sexual health, dependency, and how we function daily. We’re making the conversations around psych meds transparent, unfiltered, and a little unhinged (as it should be).

Takeaways
✔ Psychiatric meds can absolutely be ranked like high school superlatives—because why not?
 ✔ SSRIs (Lexapro, Zoloft, etc.) are commonly prescribed but affect everyone differently.
✔ Stacking Wellbutrin with SSRIs can help mitigate sexual side effects.
✔ Benzos (Xanax, Ativan) work fast but can lead to dependency & withdrawals.
✔ Seroquel? The “knocks-you-out” MVP of sedation.
✔ ADHD meds are vital, but stigma makes them misunderstood.
✔ Post-SSRI sexual dysfunction is a real issue that no one talks about enough.
✔ Open convos about medications, sexual health, and side effects need to happen more.
✔ Adderall’s hype is real, but misinformation makes it a hot topic.
✔ The psych med convo needs more honesty, less stigma, and better transparency.

Chapters
⏳ 00:00 – Intro: Mental Health Meds & Their High School Awards
 📖 00:36 – Superlative Awards for Psychiatric Medications
 🍆 04:34 – The Impact of SSRIs on Sexual Health (Let’s Be Real)
 💊 09:56 – Benzodiazepines: Fast-Acting but High Risk
 ⚡ 11:32 – The Stimulant Debate: ADHD Medications & Social Stigma
 🎤 21:11 – Closing Thoughts & What Needs to Change

🎧 Listen Now on Spotify, Apple Podcasts, YouTube & ANYWHERE you get your podcasts!

Transcript

Maria Ingalla (00:00)
Hey guys, welcome to Brain Trash. My name is Maria and I'm a psychiatric nurse practitioner.

Tabitha (00:04)
And I'm Tabitha, I'm also a psychiatric nurse practitioner.

Maria Ingalla (00:07)
And this is our podcast where we get to talk about all the weird and fascinating things about mental health, about psychiatry, about the brain, about why our mental health system in America currently sucks and throw it on the table with no bullshit. So let's just like get into some interesting things today about medications. We've talked a lot about neurodivergence. We've talked about connective tissues. We've talked about some of the executive orders going on in the past couple of weeks. And today we just want to kind of do a fun vibe on medication. So let's talk about.

If medications were in the high school yearbook, what would that look like? Who's winning what? All the awards.

Alright, first up today, most likely to succeed. Who's your vote, Tabitha?

Tabitha (00:48)
I mean, as long as they're not bipolar, LexPro, or Zoloft.

Maria Ingalla (00:52)
Why is Lexapro your favorite?

Tabitha (00:53)
I actually think Zoloft might be my favorite. I feel like with a very close following of Lexapro. I don't know, just people do well on it.

Maria Ingalla (01:03)
Overall, okay. I would say Abilify. I think you probably have kind of like a higher population of just like adults that you see. And I've spent a long time seeing children. And I think like I've tried a lot of the SSRIs with kids and sometimes they're coming to me after being on everything and like nothing worked. And then we put in some Abilify and it's like magic. And I always tell people within like four days you're gonna be like in a better spot unless you get akathisia, meaning like.

that awful restlessness that makes you want to die, then it's not really going to succeed anymore. You're probably just going to be on your way to, you know, urgent care or back to your doctor to beg you to get off of it. But overall, I that's the best one.

Tabitha (01:40)
I feel like

I would start there more often if people weren't so fucking scared because it's called an antipsychotic, right? I hate how we name medications in psychiatry. I think that the groupings are kind of fucked. And so people end up being like, my gosh, that's really scary. I don't want to take that.

Maria Ingalla (01:56)
You know what? He's like most likely to succeed, but most set up to fail. So Abilify, you got my vote. All right, best bromance.

Tabitha (02:07)
Probably like an SSRI and well butrin, because people are like, oh man, I can't get an erection or I can't have an orgasm. We're like, here's your best friend, well butrin, and then everything's fine.

Maria Ingalla (02:19)
How often do you see that actually works?

Tabitha (02:21)
I mean, a good bit, but here's the thing, is I also think that time helps, and so the amount of time it takes somebody to say something about it, start Wellbutrin, and then see a difference, I think also could just be that they are further away from the start of taking the SSRI, which often helps.

Maria Ingalla (02:40)
Yeah, I actually really like the combo in general because I think like the Wilbutrin hits the dopamine and the norepinephrine and then the the lexapro or whatever the SSRI is is already doing the serotonin so you get like the whole spectrum of all of the the chemicals for depression so like personally taking that combo I love it would always

Tabitha (03:00)
Especially for the

emotional blending that people see with higher doses of SSRIs, think the Wellbutrin offsets that.

Maria Ingalla (03:08)
Yeah, so what that's caused by is when we take an SSRI for a long time and that serotonin goes up, eventually what happens is dopamine starts decreasing. So then we have more of like, blah, I don't feel good. I don't have any motivation. And we see kind of like the increase in all of the low dopamine symptoms. So putting in a little well butrin there kind of corrects that and keeps the balance in place. So we don't have this like downstream decrease, which I've always loved.

Also another contender, guanfacine and Adderall. It's a fave, being in child psych. Guanfacine, chilling out the norepinephrine and keeping everything super regulated, helping you sleep good, helping the impulse control go down, the hyperactivity. And then you put that like stimulant in and it's like the inattentiveness goes away and you just have like this magical combination. When it works, it really fucking works.

Tabitha (03:59)
I also really like this for adult men. I find that women don't really love the like, guanfecine or clonidine situation, but like adult men are just like, wow, this is amazing.

Maria Ingalla (04:01)
I don't know.

Interesting. And like, you know, I think a lot of adult men have a lot more of that like external hyperactivity component and like impulsivity component, which the guanfacine helps more with and women have that more internal restlessness, which it doesn't do as much for. But I do love guanfacine. So we talked a little bit about boners getting ruined. On that note, who is most likely to fuck up your sex life?

Tabitha (04:34)
Best way to ruin a boner is Paxil for sure.

Maria Ingalla (04:37)
Yes, and for women too. Like if you want to like prolong an orgasm, never orgasm again, take some Paxil. I've actually only ever prescribed Paxil to people who have hypersexuality, not from bipolar, to kill their boners. I don't understand why other people would start it. Like why?

Tabitha (04:40)
Ladybug.

I've had people just be like, my entire family does great on Paxil, I wanna take Paxil. And I'm like, are you sure about that?

Maria Ingalla (04:58)
Do you want to ever have sex again? Basically.

Tabitha (05:01)
Right. Well,

and I mean, here's the thing is that if that is the only thing that makes somebody want to live, I don't know, like have an orgasm or want to live. That could be different for different people in terms of priorities between the two, but you know.

Maria Ingalla (05:12)
Yeah, that's true.

And not necessarily everybody is totally gonna get killed by being on an SSRI for their sex drive. But there is something that people don't talk enough about and it's the, it's like post SSRI inability to ever have like sexual pleasure again. Have you heard of that? PSS's are.

Tabitha (05:32)
I have heard of it before,

but I've not ever seen it in practice.

Maria Ingalla (05:36)
I've had like people hit me up a lot on TikTok for

So it's called post SSRI sexual dysfunction. There are people who say like it is irreversible, especially like with men who experience this. So they take an SSRI for a short period of time and even after getting off of it, they still encounter abilities, like an inability to get an erection or to have sex or enjoy sex, which is wild. And it's like not often talked about. And I think a lot of people just kind of like stick men on these medications and are like,

Nah, you'll be fine. And then it doesn't happen like that. But there's like a huge like movement on Reddit about this too.

Tabitha (06:12)
I feel like most of the time if somebody is complaining that it is so distressing that they're having sexual side effects and we end up stopping the SSRI, they're like, yeah, no, it's like 100 % the moment I stopped. And I'm like, cool, good for you. Here's the other thing too, though. I feel like a big part of this also depends on the way that the provider presents this information. I've had people tell me like, yeah, the first time I ever took an SSRI.

my provider was like, yeah, you might have sexual side effects. And they were like, what do you mean sexual side effects? And the provider's like, well, you know, when you're like about to orgasm and you're like, and then you just can't. I'm like, that person is visualizing in their mind, their psychiatric provider making a face of pretending to orgasm. Like nobody's gonna, nobody's gonna be okay with that. And so I feel like sometimes the way that we approach it too, like contributes to that because it's, I don't know.

Maria Ingalla (06:55)
you

Tabitha (07:02)
a topic not a lot of people like to just talk about, but I'm always like, how's your boner? You know, like I just throw it out there.

Maria Ingalla (07:07)
It's I think.

Yeah,

that's actually a good point. saw something on a Facebook group the other day about, I don't know, there was a nursing school program that was talking about sexual health and people were panicking on it, being like, we shouldn't be talking about these things. my God, why are we letting nursing students talk about orgasms and about all of these things? But we are the people who have to have these conversations with the patient and have to ask the patient, do you have any sexual discomfort? Do you have any like...

differences in like your sexual experience or your masturbation or like whatever and if you can't talk about those things then what are you supposed to do? Like how are you gonna assess the side effects? wait we just don't and then the patient feels awkward being like, hello I cannot get a boner with my partner and I mean that's hard to bring up.

Tabitha (07:52)
I've had people like trying to say it and I can, know what they're going to say, but I like have to kind of lead the questions that I can tell they're embarrassed to talk about it. And then leading them to a place where it's like without saying it being like, yeah, that's my fault. You it's actually not a you problem.

Maria Ingalla (08:05)
Yeah, yeah, and then I think,

yeah, and there's a lot of like, I think, gaslighting that goes into that kind of like, well, it's not that big of a deal. It's just kind of a side effect that can happen. Like it can't be that bad. Just like try harder. It's like, I'm not sure that's like the solution or like.

Tabitha (08:23)
I also

think people's sexual well-being and their intimate relationships and stuff is really important to their mental health. Obviously some people are asexual or it doesn't play that big of a role in their mental health, but if this is a way that you get to connect with your partner and if your partner can tell that you're not having a good time and they don't want to engage in these behaviors with you if you're not having a good time.

that can get in the way of that, right? So there's a lot of different ways that it can impact people, not just stuff like, I can't get a boner. It's like, there's other considerations too. And again, it's one of those risk versus benefit things like.

Maria Ingalla (08:57)
Yeah, and like I think the post SSRI sexual dysfunction is a lifetime thing where you're not able to work out something like for the rest of your life when people are on that. So like there's like very minimal research. I've looked at some of it, but this is maybe like one of the things that should be researched if they want to focus on men's research is like how to fix that. if that has happened and people have damage, then maybe, I don't know, somebody should look at helping them because that's traumatizing.

Tabitha (09:24)
Have you read it all? What's the underlying mechanism of that? What's the reason?

Maria Ingalla (09:27)
I don't know, dude. That would be something to look into and maybe have an episode on. But it's like there's a few articles on it. And I remember getting a couple questions on it and I really looked into it and I was like, holy crap, this is really a thing. And there's a lot of people on Reddit who've experienced that and total decimation of their ability to have sex after that. So we should look at that because I'm interested. Because there must have to be some way to help, right? I don't understand,

Do know what I mean? Like, wouldn't there be like a point where you'd be like, I have this hot new partner or like, I'm just like really feeling it. I'm looking really quick at like the mechanism and essentially it's like desensitization of the serotonin influences sexual function in general, reduced dump of mean function.

Norepinephrine dysfunction. So like the norepinephrine is what kind of causes the erectile dysfunction. And then the hormone disruptions on top of that, like the prolactin levels can cause low testosterone. okay, so like nerve damage and nerve desensitization in genital tissue, genital numbness, hallmark symptom of PSSD.

So that's what they think is it, is that it would lead to nerve desensitization in genital tissue and altered nitric oxide signaling that would impair blood flow. And then sometimes there's like thoughts about like epigenetic changes that would affect hormones. It's just really interesting that it would like impair parasympathetic activity,

Parasympathetic nervous system should be on in order to orgasm because you need to be relaxed. interesting. It's thought that like adding Bupropion or Boostbar could be beneficial, but I would imagine people who have had their sex lives ruined by SSRIs would not want to be taking any more medications.

Tabitha (11:23)
Right. Right.

Maria Ingalla (11:23)
But yeah, would say okay, SSRIs are gonna be right on board here to ruin your sex life. Most likely to get cancelled.

Tabitha (11:32)
100 % Benzos. Like, no question.

Maria Ingalla (11:34)
Yeah. Do you want to

cancel Benzos?

Tabitha (11:38)
here's thing, Benzos are amazing. They do their job, they're good at what they do, and they also blow in a lot of ways. I think that if you're taking it, you know, once a year to have a traumatic dental procedure, cool, go for it. Or to get your blood drawn, because you have needle phobia or something like that.

But, I mean, I could go real far into like how much I really hate people being on like TID benzos three times a day, every day, for years and years before somebody says, hey, this actually isn't a great idea.

Maria Ingalla (12:14)
Agreed. I think funerals, airplanes, phobias, things like that, totally has a place, totally beneficial. But when we're looking at daily use, we have now put on a band-aid that can harm people. And if you abruptly forget your benzos, which I don't think you would because you'd be having withdrawal symptoms, but you will have withdrawal symptoms is kind of the issue there. So there are reasons that prescribers don't want to do benzos, being that there was a huge boom.

that people put a lot of people on benzos, being that, like, especially housewives who were anxious and probably in domestic violence situations. And then they were on benzos for their lives and hooked on them. And we see now that there are memory issues that come from them. So there are strong reasons we want to cancel the benzos over here in the psychiatry realm. So if you've ever wondered.

Tabitha (13:04)
Yeah, I mean,

literally every piece of reputable text that gives guidance on medications is going to tell you, if it is regular use, two weeks is the longest, and then after that they need to be tapered off. So these humans that are being put on three times daily benzos for years and years, it's not, you know, necessarily their own fault that this is happening, but I think that that kind of prescribing needs to get canceled, like, ASAP.

Maria Ingalla (13:30)
would

Tabitha (13:31)
All right. Most likely to sleep through your alarm.

Maria Ingalla (13:34)
feel like there's a couple. Trazadone could be one. But I'm gonna say Seroquel is gonna be kind of our hottest answer for the most sedating out of all of them. Once you hit like 100 milligrams, you're at a pretty high dose of like, I'm gonna go to sleep. Let me get some sleep. But also Olanzapine is kind of nice. But you know, he's not gonna win this one. Seroquel is still gonna win it. She's the winner. Yeah, I feel like Seroquel fucking knocks you out. It's a winner.

Tabitha (14:00)
Yeah, most people

that talk about mourning drowsiness is... Seroquel. I mean, closely follow my trazodome, but sericul for sure.

Maria Ingalla (14:06)
Unless you get over... And

like if you get over 200, Syrup was not a contender anymore, but under 200, she's a contender.

Tabitha (14:14)
and that histamine all in the right ways.

Maria Ingalla (14:16)
Yes.

Tabitha (14:17)
Okay, let's see, most likely to be your snack time buddy.

Maria Ingalla (14:21)
my God, Alanzapine forever. Like this could also be like a contender for best bromance is like Alanzapine and either GLP-1 or Metformin, because they should be like BFFs and like staying together forever, because otherwise you're gonna be, you're gonna be kind of having the munchies. So if you've ever like smoked some weed and been like, man, I could just have so many snacks right now. Alanzapine's like that on steroids. Like 20 pounds is coming up real quick. You wanna like be able to like.

for the Super Bowl and you got a buffet coming up you really want to try everything, Alanzapine's your girl.

Tabitha (14:55)
I like how they're all gendered. Sarah Quill is a girl.

Maria Ingalla (14:57)
I know.

a girl, Sarah. Our next one needs

to have like, she maybe she can be like non-binary or they. Okay, we got they pronouns for our next little homie coming up. Most likely to ruin your family road trip.

Tabitha (15:05)
Yeah.

Also a few really great contenders here because I feel like a lot of things could ruin your road trip if you didn't have them. Number one though, I'd probably say an SNRI, something like a FxR or a  right? If you don't have those and you're like super short half-life, six, eight hours, your road trip is gonna be fucked. Like pretty short into that. And then everybody can just like have a meltdown together, you know? Like yelling in the RV at each other.

Maria Ingalla (15:40)
you

Tabitha (15:43)
nonstop until, you know, for the foreseeable future. I think also, obviously, another good one would be something like a stimulant. If you're having to drive the family vehicle on a road trip and you don't take your meds, you might get an accident.

Maria Ingalla (15:58)
Yeah,

you know safe point to point out that like people who are ADHD and not taking their stimulants Might get into more car accidents. I personally have crashed seven out of eight vehicles that I've ever driven Not all my cars really unfortunate. One of them is I'm still paying on it and then you know, that's a problem anyways but

Tabitha (16:21)
Yeah, I've only

crashed cars unmedicated as well. you know, there's, mean, there's tons, tons of research and I feel like that could be an entire episode in and of itself too. Like the risk for car accidents, the risk for substance use disorders, the risk for teenage pregnancy, all of these things. Drowning.

Maria Ingalla (16:38)
drowning, drowning. I do remember like

when my first job interview ever as a psych NP, like I had a medical doctor who asked me like, how do you feel about stimulants on the weekends? And I was like, you know, I think, I think it's okay. It's okay if people want to take breaks. And he was like, breaks are never okay. And I was like, okay, educate me. So he was like, imagine if you were a child and you took a break and you were swimming in a pool and you had ADHD and you forgot where the ladder was and you didn't get out and you drowned. And I was like,

Okay, and like now being late diagnosed with ADHD and swimming, I don't think I've ever forgotten where the ladder was. We're like, what kind of like large pool are you in that there's like not accessible ladders? I don't know if that was like a personal experience that person had. I'd like to know, but I always think about that now when we think about like ADHD and death.

Tabitha (17:30)
Well, I feel like a lot of people though, like they'll be told, like only take this on the days that you really need to get something done. And I'll have people come to me from other providers like, well they told me to skip it on the weekends. And I'm like, I mean, I see the argument on both sides, but like also we're not medicating ADHD to be productivity robots at work, right? Yes, doing things that work well is a good byproduct of medicating ADHD, but like, I also want to like engage more with my family and do my chores at home and.

you know, get my laundry done on the weekends and shit like that. So like, I'ma take it on the weekends.

Maria Ingalla (18:02)
And that might actually help you plan your family road trip and like know where you're going and not take the wrong exit and not crash your car. Cause like also when I don't take my meds, I take the wrong exit. I will just be going forever the wrong way. And you know who pokes it out? My, three year old daughter can tell me I go the wrong way. I take the wrong exit, dude. I literally go the wrong way all the time. And she's like, mom, it's wrong. And I was like, how do you know you're three and your face the wrong way? Your car seats literally looking the wrong way. And she knows, dude, that's so messed up, but that tells you like, you need your meds.

Tabitha (18:05)
Yeah.

Mm-hmm.

Maria Ingalla (18:32)
Not having Addy, that fucks up everything. Favorite, who is the most likely to wear skinny jeans in 2025?

Tabitha (18:41)
I feel like, I feel like PCAs, right? Like they're just still trying to be, they're still trying to be in the game. And, you know, I mean, sure, there's some, there's some good times where skinny jeans may be necessary.

Maria Ingalla (18:49)
They're OGs.

I mean, like, I'm not gonna lie, I still wear skinny jeans. I feel like that's part of like the emo millennial movement where like you just did and I still feel like I look great in them and like TikTok tells me it's not true. But I'm vibing with like amitriptyline that it could be okay in 2025.

Tabitha (18:58)
same.

Maybe. I have all of these, like, Gen Z, Gen Alphas that come in with their, like, crew socks and flared jeans, and I've got my little ankle socks and skinny jeans on. And they know. I see them looking. They know. They look straight down, they go, this bitch is a millennial.

Maria Ingalla (19:31)
You know how sad is like I literally look at the ankle socks and like the crew socks. The crew socks I get so much anxiety still because of like the bullying from high school. It's like they have no idea how bad it was. Like you were like the target if you wore crew socks, especially if they were like over your pants. That's like a Halloween costume back in the day. Like if you wanted to be like the nerd, you'd wear that. my God, my anxiety. Okay.

Tabitha (19:50)
yeah, no, absolutely not.

Maria Ingalla (20:00)
And then we have our last one I'll let you present.

Tabitha (20:04)
Okay, most popular.

Maria Ingalla (20:07)
easily medication that everybody comes in, they want it, they think it's going to work, they think it is the solution to all of the problems, and sometimes it is, Adderall.

feel like this is our one that gets a lot of anger from prescribers being like, everybody just wants Adderall! But sometimes people take it and it works and that makes sense. And sometimes people just think, like you said, we're supposed to be productivity robots and they're gonna be able to get all of this stuff done and complete everything. And yeah, Adderall has pretty much won the party here.

Tabitha (20:43)
I mean, I think there are reasons it gets stigmatized because of the way that, you know, they get used by college kids, take it in middle of the night to cram for a test. They don't have ADHD. They look like crackheads just flipping through their textbook, right? However, I think, I think she's the most, I think they're the most popular because they work, right? Like, yeah, it's something that can be so life-changing for so many people that I ain't mad about it.

Maria Ingalla (21:00)
They're the most popular.

for a lot of people.

with you on it. feel like total game changer and totally like hard to get popular. So popular, literally the pharmacies don't have it. Shortages. Yep. Hiding. Secretive. Like we want to we want to get to them. They won't let us there. You know, gatekeeping everywhere about it.

Tabitha (21:21)
Yeah, just hiding in the shadows.

too cool for us.

Mm-hmm. Mm-hmm. No paparazzi.

Maria Ingalla (21:34)
That's totally it. Most likely to be famous, probably. Also, our homie Addy.

Tabitha (21:41)
Also, everybody's like, my god, my therapist said that I should try Vybance. Everybody's way into it, and I'm like, okay, what else?

Maria Ingalla (21:47)
Yeah.

Well, I mean, because like therapists, I guess they're having like their life changing experience being like late diagnosed, being like, wow, this has been such a game changer. And they want to like just do something. Is it like all like ADHD? It's a lot of Yeah. And like depression, anxiety, trauma, pretty much like there's reasons why we're in this field.

Tabitha (21:54)
Yeah, do you know how many therapists I see?

I mean, a lot of it, yeah. Not all, but...

Maria Ingalla (22:09)
Yeah, if you want a, if you are a therapist and you're looking for a prescriber in Arizona, we apparently have a specialist coming out. She's got a long wait list. All right. Thanks for tuning in to our superlative episode of Brain Trash from DSM to Dumpster Fire. Hopefully we gave you some insight on some new things. If you have never heard of the post SSRI sexual dysfunction, might be worth looking at.

Tabitha (22:14)
You're coming at me.

Ha ha ha.

Maria Ingalla (22:36)
We'll probably have an episode about that soon too, but hit subscribe, like, leave us a comment, let us know what you thought, and we'll see you guys next week.