You don't need to listen to this podcast to understand holiday stress, but tune in and you will

learn three unique holiday stresses that worsen bipolar disorder and a new drug interaction

between lithium and samadluetide, aka Ozympic.

Welcome to the Carlatte Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat Report, and I'm all alone this holiday as our co-host Kelly Newsom is away at a conference, so I thought I'd do a Christmas special.

Psychiatric practice has its seasons, and this time

a year, there's a steady build-up of patients who dread the holiday season. The reasons are many.

Some are left out of holiday gatherings. Others feel forced to attend and face awkward questions

about what they are up to in life, something

people who are living on disability or just dropped out of school due to mental illness

would rather not explain. Then there are patients who feel the burden of hosting parties themselves,

buying presents and organizing parties. Not easy to do when your frontal lobes have ground to a halt,

and you can't prioritize the steps of even the simplest of tasks, like getting dressed or brushing your

teeth. Family traumas get reactivated. Dormant addictions are challenged by the chocolate bobbkas and

Yuletide wine. Then there's

winter depression. One in five people have some degree of winter shifts into depressive symptoms,

particularly those atypical ones of overeating, oversleeping, and leaden paralysis. That's one in five for some degree of seasonal shifts. The number

is much lower, around 5% for seasonal depression. But for patients with bipolar disorder,

these seasonal shifts are pretty high, approaching 50% of patients with bipolar whose mood worsens in the wintertime. It is the morning

light that is missing in winter depression as the sun comes up later and with less intensity,

particularly for people living north of, say, Tulsa, Oklahoma, or Charlotte, North Carolina.

And if your patient uses light therapy for winter depression,

...