In episode 362, James and Mike invite Bruce Arroll back to talk about his latest systematic review on antidepressants for treatment of depression in primary care. We quickly come to the realization that primary care is different than specialty care and that we need to talk first and prescribe later and have the clinician be the drug.

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In episode 361, James and Mike pull out the PREMIUM card and we digest two recent publications – a cohort study looking at the relation between percent of macronutrients ingested and CVD and mortality and then a much smaller trial of intensive lifestyle in T2DM.

In episode 360, Mike and James finally get to the end of their agitating three part series on treating agitation in dementia. In this episode we talk about the evidence for the non-drug treatments like group or individual activities, music therapy and sensory interventions. Sadly, there is still real uncertainty if these interventions work reliably.

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In episode 359, Mike and James continue to agitate over the evidence for treating agitation in dementia. We talk about the use of benzodiazepines, antidepressants cholinesterase inhibitors for this difficult to treat condition. The evidence ends up just increasing our level of agitation as these agents unfortunately really don’t do a heck of a lot for many people.

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In episode 358, Mike and James in an agitated and demented way deal with the evidence around agitation in dementia. We find that the antipsychotics have an effect that might be noticeable in 1 in 10 people but if a person responds it likely had nothing to do with the medication. How agitating is that?

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In episode 357. Mike and James invite Adrienne to help us work through all the studies that have looked at using riboflavin to prevent migraines. Unfortunately, the impact of riboflavin on migraines is consistently inconsistent and most RCTs found no reduction in migraine frequency. At least we have evidence for low-dose propranolol and amitriptyline.

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In episode 356, Mike and James welcome Jamal Ramji to the podcast because we really needed to do something PREMIUM. We discuss a study of subclinical hypothyroidism and a low FODMAP diet for IBS. At the end we figure out that TSH is a no, but that the low FODMAP is a yes at least for 1 in 5-10 people.

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In episode 355, James and Mike finish delving into the issues around lab reporting and measurements. We finally get to some potential solutions (sort of) with how to deal with the variation seen around all lab values/measurements.