THE GAUNTLET COURSE

Embark on a transformative journey through the intricate, sometimes hazardous, world of psychotropic medication trials. This course equips you with the knowledge, insights, tools, and confidence to successfully navigate the challenges and complexities of these trials safely and effectively, including how better to communicate and collaborate with your provider.   There are many potential pitfalls, particularly early in a treatment course, or for those individuals with little experience working with mental health providers or taking medications of this kind.  For those who have already survived a gauntlet of difficult or disappointing medication trials–some more than once–this course will help you truly gain understanding from those unfavorable experiences, and hopefully inspire you to again join forces with an expert and re-challenge with the right kind(s) of medication(s) in a carefully-formulated and judiciously-administered master treatment plan for a better outcome. Join me in unlocking the secrets to mastering psychotropic medication trials, to minimize their number and quickly and safely find the medication or combination of medications that will best serve you. This Course is perfect for the individual who is contemplating submitting to a psychotropic medication trial for the very first time, as well as for individuals who have had negative past experiences but who are considering rechallenging, and everyone in between: those currently taking medication, but who continue to have many unanswered questions and doubts about the efficacy and advisability of their current regimens. The course begins with a series of videos that discuss expectations, settings and the various types of mental health providers and their credentials, how these powerful variables affect the outcome of any trial, a priori factors that are often not properly considered before embarking on a trial of mind- and mood-altering medication.  Patients are not naturally inclined to scrutinize their outlook, both positive and negative ideas (many of which are subliminal), that can spell success or failure before the first pill is ever swallowed.  Part One encourages you to first take a fearless personal inventory, and helps you to evaluate the appropriateness of a psychotropic medication trial, given the nature of your symptoms, their probable cause(s), what you expect from treatment, and what else you are willing to do to find answers and craft solutions.   The video series in Part Two contains a wealth of information about the syndromal nature of psychiatric diagnoses, and the importance of a target-symptom based approach in the initial selection of medication.  Following a discussion about informed consent and how to conduct a risk/benefit analysis with your doctor before you even accept a prescription, I discuss how it is always a mistake to then subsequently resort to searching the internet aimlessly for answers to questions your own clinician should be able to better provide.  Even the best independent researchers are wasting their efforts if they have an experienced provider at their disposal.  For those individuals who nonetheless feel compelled to conduct their own forays into what the prescribed medicine is and how it may affect them, I do explore the new world of AI-assisted research (which is irrefutably better); however, this creates a whole new set of pitfalls, and this Course will tell you exactly why it is generally a huge waste of time.   **The Course is also appropriate for providers-in-training, and section Two is especially useful to future doctors, nurse practitioners, et al. Part Two continues with videos that explore the foundations of the doctor-patient relationship, including how to ensure that you and your provider are speaking the same language–literally.  This section of the Course reviews your rights and responsibilities as a patient: the basic do's and dont's that will get you off to a good start.  It teaches you what to expect from a competent and engaged provider, and enumerates the specific questions you need to ask, if the practitioner has not already answered them.  It also reveals red flags that, should they be encountered, are strong indicators that you should turn back and try again with a new provider! Part Three delves into the specific pitfalls of early treatment with psychotropic medication, for the neophyte and veteran alike, with videos exploring the nature and probability of placebo and nocebo responses, how to recognize them and what the implications are to treatment; the nature and probability of paradoxical reactions, and how to handle those; and basic tenets regarding the dose-dependent nature of most side effects, how best to obviate them entirely by properly dosing, titrating and administering psychotropic agents, and how to mitigate the unavoidable few that might otherwise threaten to derail treatment.  The latter includes a discussion about latent side effects, effects that are not typically present early on, but that appear later in the course of chronic therapy, many of them potential dealbreakers that arise with escalating doses.  No discourse on side effects would be complete, of course, without dedicated discussions about potential weight gain and sexual dysfunction; the Course devotes entire videos to each topic, with surprising information that includes actionable pearls of wisdom. Part Four is devoted to the concept of sabotage.  It focuses on the anxious patient, on the particular challenges experienced by individuals suffering from endogenous conditions like Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Social Phobia and others–difficulties that can be surmounted, but the overcoming of which depends upon a strong therapeutic alliance between doctor and patient, and proactive measures taken by the individual otherwise tempted to abort the trial after only a few doses. To this point, the Course has focused on issues which largely have to do with tolerability (the main reason patients abandon trials before they are well-underway).  Like the sections before it, Section Five is divided into several sub-sections, each with its own dedicated video, independently examining the major classes of psychotropic agents, and how best to navigate trials specific to those medications, but Part Five also delves into specific efficacy issues: is the medication in question expected to work, how soon, in what manner and WHY?  These are explanations that, sadly, patients rarely, if ever, have sufficient time with their prescribers to adequately explore.  While efficacy cannot be entirely predicted, this section of the Course will include valuable information to take back to your prescriber for further discussion, clarification and possible implementation.  It examines a few important mechanisms of action, and discusses why the classes of medications that comprise them might be preferable agents for certain target symptoms and known conditions, all other things being equal.   This section also includes a video that briefly discusses advanced psychopharmacologic techniques: combination strategies to consider if monotherapy (treatment with a single agent) fails to result in remission, or else falls short of the goal, including how best to pair primary agents with other medications for co-morbid conditions like insomnia, chronic pain, and a range of psychosomatic conditions, from migraine headaches to Irritable Bowel Syndrome.  Here again, novice practitioners have much to learn, information they can then take back to their own practices for application and additional learning by that best of teachers: experience. Part Six discusses long-term treatment protocols and the implications of lifelong, or indefinite, treatment plans, including controversial agents like benzodiazepines. For patients who do not plan to take psychotropic medication indefinitely, this section contains a special video describing various specific medication withdrawal syndromes, and how best to avoid and manage them.  A great many patients have  complained of terrible experiences trying to wean certain agents, but in my considerable experience, having treated tens of thousands of patients, I have not found discontinuation syndromes to be the bane of my practice...  My conviction is that the vast majority of these individuals came off of their medication without proper guidance; it should not be that difficult to taper and discontinue a psychotropic agent, and this video sheds light on the controversy. There is more to know, and the Course is still in development, but subscribers will have unlimited lifetime access, long after the first edition is published, including any and all new videos as they are added and uploaded, or as certain lessons are expanded and refined, and updated, until the material is fully up to my exacting standards of accuracy and comprehensiveness,  while at the same time edited for ease of viewing.  I do my best to avoid a stale, didactic tone and try to make my presentations fun and interesting to watch.   A course outline, recapitulations emphasizing the take-home bullet points, self-quizzes and other written materials will also eventually be compiled and made available to lifetime subscribers, ultimately comprised by a "Gauntlet" syllabus. Pre-registration is currenty available at a discounted rate for early adopters (coupon code: EARLYADOPTER at checkout), and a drip schedule is soon to follow.  This will allow me to incorporate feedback from the first students as I continue shaping and polishing the Course material, the bulk of which are self-contained videos in the style of my YouTube Channel, "Not On an Empty Mind," so thank you if you elect to be part of that special cohort.  Providers-in-training also stand to gain much from participating in this curriculum, and this Community. This experience is dedicated to anyone who thinks they're out of options, or those who just don't know where to begin.