All right, welcome back to the podcast. I am joined today with Dr. Michael Cummings. He is a psychopharmacologist, a regular contributor to this podcast. And today we are doing part two Q&A. We may just keep this going.

We have too many questions to answer in part two. So we'll try our best. So the first one came from a listener who enjoyed an episode from back from the abyss. It's one of my friends podcasts and Craig, Dr. Craig covered. If you were stuck on a desert island, needing to treat, you know, people for the foreseeable future with only three psychiatric medications.

Which three would you choose and why?

I, by the way, I'm happy to be back. I would probably choose a dopamine antagonist, anti-psychotic. It's a bit difficult to choose which one.

I might choose something like a resparidone or haloparidol. I would also choose a mood stabilizer. The most versatile being lithium. Although if I'm on a desert island, my ability to monitor lithium may be limited.

So I would think about about proak acid, although it's coming up with a lot of issues now in terms of reproductive risk for both men and women to the point that in the EU, it's severely restricted in the UK.

Essentially women under 55 can't be prescribed to our proak acid unless they are on a permanent form of birth control.

But mood stabilizer would certainly be the second category. And then I would likely think about an anti-depressant, probably the most likely would be surgery among the SSRIs because it has the fewest interactions is fairly well tolerated by most people and can treat both depression and anxiety disorders.

Nice. Okay. So I am curious, what is the research on vow proak acid and men in pregnancy?

Basically, as people are likely to recall, among its other properties, vow proak acid is a histone deacetylase inhibitor, meaning that it blocks the acetylation of the protein that is involved in the winding and unwinding of DNA.

As it turns out, one of the side effects of inhibiting the activity of the acetylation of histone is to increase methylation in sperm DNA.

First in animals, they discovered that was related to neurocognitive, neurobehavioral problems in mice.

Just recently, I believe it was Sweden, Finland, and Norway conducted a registry review since they have birthed the deseradregistries and found that there was an increased rate of neurobehavioral disorders in children born to men who were taking vow proak acid within three months of their partner becoming pregnant.

This is a good education here. Okay. So as a via the FDA has not moved on any of this data, but given that the European Union and the UK have, it's very likely the FDA will require restrictions or limitations in the use of vow proak acid and then not too distant future, I would think.

Okay. I think I would lean more towards lithium personally for the motor stabilizer.

Level, I don't know, I usually get a pretty decent level at 900 to 1200. I think I would just look for side effects.

Yeah. I mean, you can certainly do it without measuring levels. And I'm presuming on my desert island, I don't have a lab.

That was good. Yeah. I think I would go more for a landsapane for the antipsychotic just because, you know, you get the sleep aid as well.

I can use it for bipolar if you needed to. Well, I guess you'd use other antipsychotics too, but it tends to be the one I go to for someone with bipolar.

And I'd probably agree with you with the search lane for the antidepressant. So yeah, pretty pretty similar.

Yes. Yeah. My hesitation with the old landsapane has to do with, of course, it's metabolic side effects.

Well, perhaps on a desert island, if we don't have them, McDonald's will be better.

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