DR. DIEGO TAVARES (DEPRESSÃO E TRANSTORNO BIPOLAR) - PODPEOPLE #162

[Music] [Music] [Music] [Music] [Music] our guest today is a psychiatrist specializing in mood disorders. He is also a professor and author of the books depression and bipolar disorder, the complexity of affective illnesses, clinical cases in bipolar disorder and conditions mixed mood from diagnosis to treatment in today's interview we will discuss your professional trajectory the impact of the study of transcranial magnetic stimulation in the treatment of bipolar disorder the use of antidepressants during pregnancy and the interactions between alcohol and psychiatric medications with you Dr Diego Tavares [ Music] Hello, everyone, welcome to another episode of pod

people, a place where we meet to see and hear people People who do People who happen, people who inspire our guest today is psychiatrist Dr Diego Tavares, how are you, my dear? Alright Alex D Ana Thank you for the invitation, it's a pleasure to have you here, thank you very much for accepting our invitation because I really admire your work because, firstly, it's great to see fellow psychiatrists speaking the way you do, spreading knowledge and in a It's such a difficult area for people to understand that they are mood disorders, right? Why do people get

stuck there? Depression, people have the idea of ​​bipolarity, it's already complicated, but then when it goes to cyclothymia, when it goes to mixed disorders, it gets a little confusing. I think this challenge is cool: you're taking this knowledge to begin with, Diego, I wanted us to talk a little about your story, what it was like choosing medicine, then psychiatry, then within psychiatry, mood disorders Look at the story, it's not as cute as we think, right, because that's how Medicine actually came after an FL for law because I really like writing this thing about writing literature

and such but then comes medicine but during all of medicine I wanted general surgery I wanted urology after a while surgery league congress of I don't know what of trauma of tananã of suture of of of what material what forceps I don't know what I didn't know what I did a residency one year of general surgery, look, discover that Theory is one thing, practice is another in what sense because the surgery are you worried about the problem uhum and it's immediate and the person is secondary there who is having that problem and when I realized

that I have to ignore the person a little and focus more on the problem and then and the whole issue that involves the logistics of surgery is very complicated, behind the scenes, it's very complex, there's a lot of pressure for results and discharge because you have to operate, but there are people going down And then there was So this divorce not with medicine but with the way medicine was being practiced within this I understood this area and then there was disenchantment there, right? Total And then, right? At the time, I had contact with people who

were in the field of Psychiatry and the person said, do you do psychiatry? a base and not just something so abstract and loose, it has nothing to do with me, he said, imagine, but nowadays psychiatry is no longer anything like what you had in college because time has passed and psychiatry has changed a lot then I said, look, it has something to do with it, yes, you 're saying something amazing because that's how psychiatry was when I started, Diego, it was super subjective like that and I said it like this, people, I want, I want

something concrete, I want to have the possibility of exams, I want to have the possibility And for a long time I was a voice alone in the universe that I said, everyone laughed and I said no, but I'm not going to arrive and they even questioned you because you passed, they questioned you and soon after and I always had a very cool exam protocol. processed by all the insurance companies for asking for these exams uhum I won all the processes thank God and there came a point that I said but now I want more I

want something that isn't just medicine and so I went to what today they are calling psychiatry uh interventionist that in reality, it's nothing new for you to look for non-medicated alternatives, which is something that I saw that you also do and study, which is magnetic stimulation, when I started magnetic stimulation 12 years ago people said you're crazy B you're inventing things today you go to conferences we don't talk about anything else so it's cool that we don't conform to medicine that is established because the patient is the objective always, right And human behavior He Can

He accepts various explanations for things, right, we come out of an era where it was religious, spiritual or later understand that H a behavior understands that there are motivations for behavior there are consequences for behavior then it falls into the brain where we you see patterns that are symptoms forming syndromes, diagnoses from 1980 are established, then behavioral contextual theories show that it is not so subjective, as we are, there is a certain amount of subjectivity because we are individual beings deep down, but it is not so how people put it as if it were a

cloud, right in the past, the person said psyche It seemed like a spirit Ah, that's from your psyche, then I've seen patients talk, but what exactly is psyche and the doctor explains it, the person still doesn't understand anything and the person has You have to understand for her to understand what's happening to her, right? Otherwise, you're left with a theory all to yourself, the person is completely lost, right, and doesn't adhere to the treatment, right, Diego, you have something that I have while you're talking about this trajectory that made me thinking and bringing up this

psychiatry that I also have, first of all, in college we don't study as much and for a long time we had that thing like the psychiatrist and psychologist have to work together but in reality one was more likely to interfere with the other There and over time I began to see the importance of getting more involved and having an understanding of psychiatry for this work because often the person is there with the psychologist and you see that he needs something more and you don't refer him because sometimes if I go to the psychiatrist and suddenly

he won't be with me anymore so that never existed for me and when I leave it for a while and I start walking together with Ana I realize how important this marriage is, you know this partnership While you were talking I realized that from the time you went to surgery and that you came back, it brings me the comfort of looking at your social networks and really realizing how much pleasure it is to look there because I see a psychiatrist who has this outlook as a whole for the patient, I I think that the time

you spent there in urology because, whether you like it or not, you are a doctor and then you studied psychiatry and I think that this experience that you brought from going through urology and going through surgery gives you more baggage for you to look at this patient as a so I think it was a very valuable time for you and the patient is people like us so it's very easy for you to understand the experiences when you are people and how you wanted to be treated and and people don't understand how much behind the scenes

of psychiatry is a thinking machine between you have energy you have difficulty feeling pleasure but you also have a difficult mother a complicated father and religion and Sexuality and Lost your job and so on And you have to put all of this together and then you have that deliver something that you want that helps the person in the end, right, if we never want it and it's not always like that because sometimes side effects come. There are several things so the psychologist really has to understand the brain of side effect medicine and the psychiatrist has

to understand that there is something that is personality, which is cognition, cognitive distortion, catastrophizing, it also needs to be worked on, which needs to be worked on, you know, behavioral, even a good psychologist who has this baggage, right, and we run away a lot nowadays, both in psychiatry and in psychology of interpretation is because Ah, it could be that the father really influenced everything, but like us, the person isn't even getting out of bed, the person is like that, that's not the important thing, so important at this moment, it's basic for them, sometimes the person

becomes Complaints like this, I have a lot of problems at work, but sometimes the way she deals with people, she doesn't realize that she pushes people away, it creates conflicts, right? no one goes to the psychiatrist because, like, Ah, I'm great, I want to reflect on the possibilities of getting better, it's still difficult, right, very difficult, so and it's the tip of the iceberg, right, because you arrive, I say, you arrive, you're bleeding, and then maybe the thing you did surgery was so cool in the sense that you have to stop the bleeding, it's when

you arrive after the bleeding has stopped, as you said, the person isn't getting up, the person doesn't want to live, there's no way you can arrive at that time and say like that oh, let's see your father, your mother, your uncle, you can't even talk to someone like that, Doctor You're not even looking at me, what's happening here with me Look here, I can't reason And you want me to talk about Pain, ahem, I can't, I'm bleeding Then I'm going to die of hemorrhage and mental illness, right, so that's so cool because only after you

so much as I. When I was working, I told Alex, Alex, this patient is going to therapy, I said, he's not even ready in three months, maybe if I play him in therapy now it has no structure and people sometimes criticize me when I say this but I have a view that therapy is not always the first process to be almost never resolved well he he knows how to understand this, he knows this and the psychiatrist also well resolved because why are we putting a patient who left the ICU to run on the beach, you

understand, there's no way to work on the process if he's weak you have to lift him and then you start this process and in the past I used to talk a lot, right, resistance, poor guy the patient doesn't even reason, he doesn't have life tension, it's not resistance, it's a lack of energy, people so much lack of putting themselves in Out's place Because it's so simple, right, the data that the person says, they're not taking a shower, they're brushing their teeth and Everything just imagine it in place, people, it's very simple, exactly, how cool is

that? And then what moment do you decide to go to psychiatry, even if you say, well, now I've turned the key, no, I'm really like this, ending like this, I didn't complete a year of exen in general surgery, then I leave, right, I make a decision that is not easy either because you say that, did I really lose everything all this time and then I went to And then when are you going to do the interview , right? with me, a person who gives up on something like this that you wanted to do your whole

life Will you not give up again? I'm insecure that I think you're a person who will really continue and won't abandon us. I said, look closely at the On the contrary, because it was very difficult for me to make that decision exactly, so I think completely differently, I think that's where they accepted me, let's say, you managed to reverse that prejudice because in reality it's a prejudice, right? Like, can we trust you? The question is, can I trust myself, you were there wanting to trust you, right? And it was very difficult to make that decision,

so if I'm here it's because I really wanted to be here because all your preparation had been for surgery. the route is very difficult And then how did I end up there in the group, which is the affective diseases group at the Hospital das Clínicas at USP, which is 42 years old now. It was a coincidence because I had some professors at the residency and then when I looked, I said I liked this guy, he thinks like me, I'm more practical, that goal, at the same time, I like to be funny like you do on

social media, that was always a conflict for me when I started on social media because we suffer a lot of judgment when you It's at the same time within the university and at the same time on social media, right, today it's improved, it's going to improve profoundly in 10 years, NM will have this, but mainly from colleagues It's not from the public, it's not from the public, it's from colleagues because it's an image that exactly an image is built that is as if you were joking you are not a competent and trustworthy person and it

has nothing to do with you bringing lightness to something that is difficult and that you will access many more people because they will not read the book and they don't even care about reading the book, but before that, it was in the group and so on, they welcomed me very well, it's a group I've been in since the beginning I've always been very respected, everything I wanted to do, I had it cool. So I'm very grateful for that. And throughout this work in the group, I also got to know the magnetic stimulation service, Professor André

Brunoni, he's the biggest deit publisher in the world. precursor also suffered a lot but is today respected for the results he obtained and for the people and and always gave a lot of opportunities so and for the results, right, it's not just for the results, it's a fact it's a fact in front of facts it's And then I, in the last year of residency, he said, do you want to conduct a randomized controlled clinical trial on deep magnetic stimulation, which is a machine that doesn't even exist in Brazil today, it comes on loan from Israel,

it's only available in the service, and it's already gone, it was provided by the University there at the time because it was very expensive. galardon who worked with you he was there at that time doing his clinical trial guys you had access to the Prof fund access And then we did one on the blind man with bipolar 1 and two with depression and it gave a positive result indifference from the Placebo and this was published And then it was that We said, bipolar depression also works, apparently, so there's a fear, right, a fear, you wouldn't

turn around or not work because sometimes a lot of things don't work in bipolar depression because the mechanism is totally different And then this opportunity was given and that's how I am. very methodical, organized and clinical, you have to be patient, sometimes they get upset Ah, but you didn't include me, what do I have to tell you for me to include you? I said no, it's not like that, there's a protocol here and we have to obey that And then we use a lot of The Strategy won't benefit you So And it's also true that

we are not for this audience so your framework so doing research involves a lot of this too, right, you have to choose a very specific niche so that the conclusions are really reliable, right, there's no mixture of things there, not exactly And that was it And then we did research there and it doesn't stick to that over time, when the machine left, it was a sensation but it was cool because it's profound, I already think the wonderful transcranial magnetic stimulation uhum we've been working with it for a long time and it's before and after the

results of you being able to act more quickly we never admitted a patient again That was something like that we didn't admit a patient arrived that we were dealing with dysentery is doing the protocols but like this, imagine, deep, deep, I always knew it was just for university services, right, because it was something, I remember that at the time, it was 2013, more or less, it cost 1 million and for me the machine, something like that, today it must be for the correction, it's going to be about five, if we're going to play the correction,

right, so it's in this and it's good that destigmatizing the type, oh, there's a brain down there that is part of your behavior, it helped electroconvulsive therapy also come to the public, right, as a possibility for those who also they didn't respond to medicines or magnetic stimulation remdi and and because at the beginning when I was on social media I talked about electroconvulsive therapy, someone would arrive like this and I would read the comments I saw a married lady with children, a housewife telling me to put that machine in in the back hole my mother

because that was absurd and I don't know what you are this you are that and then we had to say calm down it's not like that you don't understand things changing this in Brazil was very marked because the people, during the dictatorship, used electroshock machines to shock the brain, because the brain doesn't feel pain . The dysfunctional and punitive use of a technique is like taking a cardiac cardioversion device and shocking people, then we're going to abolish them and resuscitate them and let everyone die because they can't use it anymore . there the person shocked

the person stopped you have to use it now you get that cardioversion go out and put it on people the culture is the same thing you're talking about and but me it's a time of today it's no longer, for example in Japan, doctors have a electroshock device little portable thing that they go home and do, it's something very peaceful, it's not all that paraphernalia that was here that was only done, I don't know where it was, something a bit mysterious, there were some very unpleasant things but it had a side effect of the miniscule issue

of móri I remember that when we had to use it it was very annoying because that memory took a while to recover and we wasted time there until the patient had therapy afterwards Because it caused memory failure, I told people that that's why I went to look for it magnetic stimulation because in magnetic stimulation, on the contrary, there was no memory effect and it had very good effects, so in terms of disposition it even improved memory, right, right, and now they are making magnet convulsion therapy devices, using magnetic stimulation to produce the convulsive crisis that

electroconvulsive therapy would produce electrically and this would greatly reduce the issue of cognitive issues, right? So there is a controlled double-blind procedure going on with the device borrowed from Magneto there at the HC with the purpose, right, of moving things forward, right, not of bringing possibilities, because the worst for the patient there is no possibility in your case, how do you say to a patient that there is nothing more to do for you, this is a death decree that you are making for the exact patient, we doctors cannot, he has great hope, right? It wo

n't be me who doesn't have the technique, I have to send it to a colleague who does but I can't give up, I can't make him give up at all, it's not our job, right ? a very beautiful trail for sure and and and of course I spent some time there at HC and it's very interesting, the Research groups you awaken something very very positive and there I believe that ah it was the place there together with the group that you He woke up due to bipolarity wanting to treat bipolarity Well, that's the choice because

he went to the clingy side, right ? researchers of depressive disorders major depressive psychotic depression postpartum depression dysthymia and they TM are also now seeing something of depression secondary to other medical illnesses vitamin B12 deficiency D deficiency yes it is a much larger group than just yes there because it became very strong because of bipolar disorder because there is D Moreno there are a lot of people we know but there is another part that works with the bipolar spectrum and then we study bipolar one two cyclothymia and other forms of bipolar disorder So not specified

like that and I thought it was very interesting because that's how we imagine mood disorders in a very black and white way , right? been with the person for many years of their life And then this leads the person and those who live with them to say no Ana is depressed even though she is closed off she talks little tired discouraged pessimistic hopeless and that is because depression I know depression the person has the her way and she has the episode then she goes back to being what she is and not when the symptoms are

milder she can be with the person for years it chronics much easier, doesn't it chronic and the Pole above can also be like this, there are people who they can carry activation symptoms for a long time of their lives, right? So the understanding when I had this understanding that in reality what will help in the diagnosis is the instability that the person has, you start to evaluate all the degrees of intensity of alteration of mood throughout a person's life, that is, from the moment they were born until the moment they die, right, they are here

in front of you today In general, people sometimes don't know that bipolar disorder is a depressive illness, uhm, a lot depressed, right? Eh, eh, and little is said about it because when someone talks about depression like this, even about secondary illnesses that we are talking about, right, people say depression, no one says it could be drunk, no one says it could be D, no one says it could be bipolar disorder people put depression together in a little ball but they constituted it there and in reality People with bipolar disorder They have more episodes of depression

throughout their life as a whole than the episodes of activation themselves So this is very complicated It's clear that bipolar disorder, type one, which is rare, 1%, shows its face because the moment comes when it comes in strong colors, it's red, it's red, it can't go unnoticed, so the person is there and they are it's usually sudden So she's sleeping in a certain way in the Greek books it was already described like this she slept in a certain way and woke up either too happy or angry and too aggressive with speech pressure talking a lot

without sleeping agitated pacing from one side to another an aggressiveness which is not always physical but is an aggressive tone of voice and saying things that hurt because she knows the family member, she knows exactly where he is going to poke her, it seems mean because the person says it like that, no Doctor, but he did it of evil I said it wasn't exactly because he is like that he is hyper he is hyper activated so he doesn't control Ah but he knows that it's like you know all the no's of that person too but

you don't leave you are in control and no will say because I can think a lot of things about the person but I say no it's not appropriate for me to say that for the love of God appropriate it's not the time what consequence of this isoa F she's not wait that there is a fog in front of the person who is in a mania that she leads the person to do things this is very in the person goes to another continent, it's ABS, a patient of mine, you know, she's even a psychologist, she went

to another continent because she was obsessed with the Egyptian and she said I'm going, I'm going there to buy a rug She told her husband I'm going to buy carpet and I'm going to sell it in Brazil and she bought the ticket, she couldn't afford it, she bought it and went and didn't sleep there and went and went to the military place, she said she was a person from Brazil that she wasn't everyone convinced believed in her because the person is super convincing super super Look what a risk what a serious situation in life life

that's what I'm telling people no there's no way it can be something Oh what's going on is a tantrum people the person puts their life on the line ex exact as well as a patient a granddaughter of a patient of mine she said this after I found out that she had a bipolar diagnosis You don't know what you did in my life you transformed the image that I I had it from my grandmother because I thought she was perverse and a psychopath, Oh my God, from time to time, but then she became good again, there

is no such thing as a psychopath, exactly, and it's so interesting because this complaint only comes from family members or acquaintances who come the flash of Mania of Super activation, right, because no one makes this complaint about depression, exactly because when you go to bipolar Type two, a lot of depressive episodes will predominate and hypomania is normally chronic between depressions And look how It's perverse because I'm hyperactive, I talk, I do things, I solve work and I don't get tired and I sleep a little less than the average, I do much more than the average

person, I stand out in society, so I depress what I say to psychiatrist I want to go back to how I was, which in reality is already a hyperactivation, it was chronic but more functional and that it is people who move the world and I tell people why are you ashamed of this optical disorder, it is hyperthymic because they are people who are carrying society's weight, judges, doctors, psychologists, psychiatrists, including former eeee entrepreneurs and builders And then, the brave ones, they cross things out, you say, people, how did that person think about that and do

it, and do everything, if you have to bet your life, sell your house, people end up like this but they have this NE then it gets depressed again then it gets better then it gets depressed again so this person always talks like that but how do I differentiate that personality that is just a little like that from an expansive person uhum because bipolar type two it depresses and then depresses then depresses then depresses then depresses it fluctuates all the time exactly and that's so common, right? That's what you call mixed disorders or not Or do

you It already starts as chronic type two, so within type two, this oscillation is as fast as if it were an electrocardiogram, it goes up, goes down, goes up, goes up, goes down, after a few years and sometimes using a lot of antidepressants, that's not because antidepressants are horrible, they don't help Many people , most people really benefit, but some people who have fluctuations that they don't realize are using it for years . which are very conflicting because at the same time that I'm agitated and doing a lot of things, I have a deep feeling

of suicide and that I'm really going to kill myself, which makes sense even though the person is doing beautiful things and is quiet and agitated with a feeling of restlessness doesn't fit, right? I say that in these chronic cases, the person doesn't fit in anywhere, they don't fit in, they don't have a place in the world, they don't have a place within themselves, they don't have a partnership because it's very common. the partners come and talk like that Doctor But what is missing for him or her to be happy said like that it has nothing

to do with you that's it doesn't fit it's internal it's an internal agony right and it's very difficult there's a very interesting video from the singer of that band, César Menotte Fabiano, he openly said that he has a depressive disorder and so on and he turns around and says to people, you don't tell people because people won't understand, it's not my good car, it's not my manor or love has nothing to do with what I see outside of me, if you were able to enter inside me and feel what I'm feeling, then we'd start talking,

then you'd start to really select the person you 'd have the courage to meet. talk about it because via irrigation what will come from there is a conversation like what you need look at your house look at your car my friend you don't understand what I'm feeling here it's very strong even when the person tries suicide people, when a person tries to commit suicide, we have no idea of ​​the pain that person is feeling, despair, despair, I always say that any suicide attempt is despair, despair, no one tries to commit suicide, it's just to get

attention, there's a despair like I can't take it anymore, right? It's like you, if I burn your foot with a decoy, right, and I'm burning, burning, burning, it's increasing to despair, it's at that maximum point that a person is at when they get the idea, I can't take it anymore, I'm going to do anything to relieve you, stop stopping me. burning kills me so all at once it kills me kills me ca cut please kill me right so that's the way the mixed state is very interesting because we follow the Americanas guidelines a lot, which

are dm and the latest research 10 years ago, they changed a little the way of understanding mixed states. In the past, the mixed state was only when the person was in a mood with a mood other than joy, that is, with irritability, anger, hatred, with air, so a lot of people think about the state mixed still like irritability but over time they realized that the depressive pole can have acceleration of thoughts within the depression and extreme difficulty sleeping when depressed so it is a mixed depression too so the poles they can have a mixture Here

down predominating down or a mixture predominating upwards which is much more complex treatment much more complex because it is very confused with anxious depression uhum but when you look at what studies have shown that mixed depression can have the classic symptoms of anxiety so I I'm scared, I'm worried, I'm anticipating the future in a negative way, I'm catastrophizing and so on, but generally here, along with this symptomatology, you'll have a very serious depression where I have suicidal behavior where I have extreme difficulty functioning on a daily basis, eh thinking that the person will say like

this I say this but your thoughts are you are anticipating that you are going to get sick or that it is going to happen Doctor it's a lot of things that I don't even know how to tell you what it is if TR In anxiety I say Doctor go happen and it won't go wrong because tomorrow I'll be on the podcast It's going to be horrible for Beatriz, it's going to ruin me, she's great, she's perfect. She already knows everything and so does Alex, he knows everything about Psychology. That's just anxiety within a person who

was depressed. of things, she doesn't even know how to tell you what to think . you don't expect the person, in fact you expect the opposite, that they won't even get out of bed, that they won't be able to have the energy to do things or have a pulse, but then they may have an increase in impulsivity. So you will see a person who is depressed but who he masturbates four times a day, like this, even in an attempt to alleviate depression. You also have to understand, you also have to understand, right? The person is

not stupid, the brain is not stupid. of anguish all the time This is the truth if we don't know how to do it the brain will do it in an automatic automatic mechanism That's why I say if you don't understand how the brain or yours works, you are doomed to do everything the brain Inter What is the better for you You're going to leave, he's going to leave, hypnotized by his own hair, he's going to look for some relief, once upon a time there was an endocrine doctor who always sent me a case and everything

like that, and so on, obese people, right, because people forget that increasing the impossibility of eating can also happen, right? and an Italian study in 1995 showed a huge group of obese people, very very obese, morbidly obese, that the rate of bipolarity was very high, that that was just the tip of the iceberg, when you look at it, it's not just the food that it eats He drinks a lot, he has sex and cheats a lot, he spends a lot, he compulsively plays cell phone games all the time, he goes on compulsions, he changes his

hair color, which is impulsive, getting a lot of tattoos, so we have to we have to dessicate the person as a whole, it's Subtle, it's Subtle, there's no point in wanting to put everything in one package, it's too Subtle and there's something that I think is beautiful like that, right, in this concept of a spectrum, right, Diego, nowadays we know what humor has a spectrum spectrum dimensionality exactly so everything can be mixed but because nature didn't read the book when we When the first diagnostic criteria appeared they took the very prototypical depressed classic of the

one in bed without taking a shower and the talking hospital maniac singing dancing euphoric It's just that nature, like pneumonia, is very serious . that you make skin color spectrum And why is behavior in nature, right? You have nature, it is spectral, all spectral, exactly, but in our attempt, you know, arrogant to understand nature, we put it in little boxes and we don't You understand that people walk, they dance, right, in this nature Why does this happen because our parents did n't say No, I'm going to look for a person who really has characteristics, no,

people meet at random and mix at random and then people come mother, grandmother's father's people from the other side and then you'll have this soup soup, right, a genetic soup, right, genetic soup of predispositions, I say it's ok because you got it wrong, what was your grandfather like, my grandfather was a multimillionaire, he built a company he worked everything but at home he would beat my grandmother because he was aggressive, also because bipolarity has that , right? worst t-shirt because no one is watching us our humor is often completely exposed and the one who is

with us is often the person's punching bag No, it's rude, they are aggressive and sometimes they cheat and sometimes they are very egocentric, anyway, many things comp is saying something so interesting and it's very common in these families where there was a grandfather, the first there who built an empire That's right, and everyone is a little hurt, they don't talk much about the great one, you know, the doer of everything, I always suspected that there was a bipol because I said it, but as he was your grandfather, my grandfather was a lot of energy, he

worked, he worked with us, a worker and we were just I saw when he was depressed I think he went into exhaustion And then we saw but he couldn't get close to the fact that he was depressed and the guy just produced it, he produced so much in the hyperactivation that even when he went into depression if there were half a dozen people to touch on that, the polarity thing has people who predominate the depressive pole, generally female, because for biological reasons the woman's brain is more prone to depression, unfortunately, and men in the family

depression, manic polarity and polarity, the symptoms above normally the person has no criticism while in depression I speak for the love of God Beatriz I have no energy I don't feel pleasure in anything I can't sleep I don't feel hungry I'm so unmotivated so everything is critical and even exacerbated because what the individual perceives of depression is greatly amplified by the black glasses of depression, it's not that bad, right? It's bad, but it's not that bad, but it's how the person sees it, right? like that, but you have to understand that there can be a

distortion. This changes a person's way of seeing things a lot, right, and at the Pole above there is a total absence of criticism, even more so, the person is a well-received person, that's it, so she's great, I know what what I do I have an increased sense of reason I have an increase in energy I have no irritability imagine you who provoke me exactly I'm just a person who says what I think and people don't like it and I feel sorry for them and the A person is not critical of their irritability or aggressiveness, which

is not always physical, it is often verbal, sometimes verbal is verbal, so it is personal, it is interesting when we talk, sometimes with family members, you know, there is a spectrum in the family and sometimes the person is polarity of S my poor son has been depressed for a long time and doesn't treat it, his father also has a trans person, something on the bipolar spectrum but I can't imagine I do it and it happens exactly I don't paralyze I don't paralyze I don't I let depression get to me, my dear, depression is not whether

or not I let my ex, if I have to get it, it will get to me, and you, whoever you are, don't have this story. Thank God, if you believe me, you weren't born with this predisposition, just like anyone else smokes a lot and doesn't have cancer, there's someone who, for some reason , doesn't show up, genetics don't express themselves, right? But you have to realize that you, sir, are impulsive, right? I work 10 hours a night 24 hours a day and he doesn't do anything so sometimes you see these generations within the same family

with things on the same spectrum but with very different characteristics and then we have to take all of this and start explaining and asking for empathy exactly for a person who sometimes doesn't know what it's like to have that from another, right? It's just the same, the opposite pole of the same thing, which is this spectrum of humor, it's beautiful, that's how it is. Sometimes the opposite happens this week I had it a surprise also in the office that the boy came and wanted to bring his father and it was not my objective. I spoke

to the father because I knew the horrible story he had in childhood with this father with characteristics of Paulo above but it was not objective and I I started to explain his bipolarity and such and suddenly the father starts to cry and say I think I have this I think I ended his life as a child because I did this I did this I did this I did this and I went through all this But in a way I hid it from everyone, I had thoughts of suicide but I never told anyone I told them

and I went to work dragging myself but then I did a lot of things I was impulsive, my mood improved I became positive and I'm here apologizing to the guy and then I said My God, it's beautiful because this changes, recognizing his paternity and changing the vision of this son, the representation he has of the past he had, right, that's it, I think it's one of the greatest pleasures of Our profession is when you reconnect parents and children through knowledge, this is so beautiful, there's an interview with Ritali, right? If she was diagnosed with bipolar,

she came out about it and everything, right ? And Marília Gabriela in the interview asks her husband, it's there on my Instagram This is this cut, right? He says it's very difficult to live with a bipolar person, isn't it, Roberto? He said Marília? The hardest part is being in the world and not knowing what's happening to that person until the diagnosis, after I know, I understand. She's irritated, that's why she was rude, that's why she's having trouble sleeping today, that's why she's not obeying and accepting my things, it's not because she hates me, it's simply

because she's in a situation and she can't, right? so it totally changes the view, right? And nowadays, on social media, we get into conflicts sometimes because some people have psychiatric diagnoses, yes, as if we had, we're thinking, no, we're freeing Liberator, my daughter, you have to understand L um Well, it's because from the moment I understand that it's not me, if you put yourself in that place, everything is empathy, I think psychiatry, psychology, if you put yourself in that place, let's imagine here a psychodrama, I'm a person who doesn't get out of bed, unable to

work before. I could do it now my family is having to pay for things for me I'm feeling burdened I'm really being it's empathy if I put myself in my place I understand that this is a diagnosis I understand that just as if I had cancer I wouldn't get or with urinary infection damn the bacteria because why did they get into me I'm incompetent why did I let them get up I don't accept it because I did it I'm to blame anyway I don't I don't you don't do that with urinary infection you don't You

keep blaming yourself because you got an infection And why can you blame yourself because your brain had a little deregulation, right? And that's what you said, right ? You have no idea how complex this is. So he said it like this , but it's simple, it's preg, people on the Psychotic spectrum, there are people who are paranoid. Alex is, I already know that they are preparing and everything and the person lives their life like this, they won't break, they will work, they will be able to have agony But it's a genetic Zinha that comes a

little bit from living as if you had always been to the point of being attacked is very distressing, it is distressing or anxiety, also sometimes the person carries it since they were little, Sensations, a boy once today, I no longer treat children or teenagers, but a psychologist sent it and said, look, there is a boy who has terrible anxiety, I I said oh no Is it really anxiety Is it a childhood thing like 8 years old the boy sits me down and says I'm really worried about acid rain Because it can corrode our skin I

saw that it can increase he had an intelligence too increased But this can run on your skin this can give you cancer everything I said but you keep thinking about it every day my son if I think about acid rain and I don't live but I can't stop not thinking you don't understand right, so that's how we learn that intrusive thought, right? And you're saying this in general , there are children in general. They have a super giftedness that today we're also starting better, right ? mental put everything in one thing, right, we brought Ozeni

Ribeiro here, wonderful, talking about giftedness And these children They have a profile of intrusive thoughts and they are very young, very very It's rare, it's not common, but when it happens, it's desperate for the child to come and say I I can't handle my thoughts and it's interesting that when you interview someone with bipolar disorder in adulthood, they talk about symptoms from childhood, you'll only notice that no one noticed, they say, doctor, there were times when I slept all afternoon, but my mother I thought Oh, she's a teenager who's sleeping, tired, she's locked in her

room, she must be listening to music, she was sleeping, and in other cases she didn't sleep and the all night long but no one noticed and that's not why I think there's one thing that I find very interesting and somehow in high school I think not only in medical school in all of them and especially in basic and medical education we had to find a way to teach this so that we can reason based on brain function because this is changing and revolutionizing the way we see ourselves, the way we see others and the way

we can relate because empathy can be trained, yes, right, through knowledge, you don't need to be obliged to have empathy, but the moment I have knowledge it becomes much easier because that student who enters school and breaks everything can be several things, including a manic episode, it can be a The crisis of someone with an oppositional defiant disorder could be several things, but we weren't taught that, I remember it like this when I studied the seventh grade at school Let's study the brain Vision Touch Hearing Taste No one talked about emotion, no one talked about

emotion, no one talked Out of anger, no one talked about sadness, look, it's easier today, and there's fun , one, two, and then the teachers organize a trip to take to the cinema. of our day, whoever is human and is not an extraterrestrial is real here, feels all of this exactly, right, or doesn't he? This has a validity, right ? out of prejudice but I can't trust it so why don't they do that? There was a time when I worked at a school when I created an emotion thermometer and gave it as a souvenir, right?

Ah, Easter is coming, the day of I don't know what and I started to think about it but there was no point because the process, alone in a school, provided that but it was just a cute thing and then I had to prepare, train the teachers, work, teachers would have math teachers, people can work with that exactly, people After I became a psychiatrist, I look back, I remember a teacher I had, I won't talk about the subject if it's not easy to identify because it was in the interior of Goiás, where I was born, that

person had changes in mood, was extremely aggressive, was extremely explosive, impulsive once threw the book and left the room and stayed away for a week, I don't know or I don't know what was going on and for us to understand and that she has an issue that she needs help from, all of us at school, the teachers, the principals, not just the students as well. right, it's such an interesting thing, this coexistence with school and today with the maturity that I have because when I entered the educational field I entered as a recent graduate so

I even managed to bring about some revolutions so that by C TDH understanding that child at the class council, but one of the things I was noticing was in the second semester at school, September, October, the teachers started to capsize and their level of irritability increased a lot, but I couldn't figure out what was happening, but this was very common, it was very common, triggering the problem. and then exactly because it was exhausting for all of us And that's what sometimes people don't understand that the brain is biological but it is in constant contact with

the environment just like the lungs if I go on the subway and Ana goes along She gets pneumonia I didn't the environment was the same there was a virus but my biological one managed to overcome more vulnerable so when it's always an equation between the biological and the external that's why psychology and psychiatry are always together, always for sure because and sometimes It's a lot of environment and sometimes it's very little of environment, there are people who have depression or spontaneous manic attacks without absolutely nothing happening in the person's life, print a bottle of soda

D because I don't know why it happened in there something a little key turned and turned And that's where I have to understand, for example, right, ah trigger for the crisis for me is going without sleep I can't go without sleep in any way this is individualized individualized the trigger is individual the patient said my trigger and my mother gets sick Doctor exactly I was fired I didn't get depressed pipolar Type two I got depressed fired I didn't get depressed my wife broke up with me I was in a relationship it wasn't good I didn't

get depressed my daughter got sick but if my mother gets sick that's the end of it. individualized this individualized the condition we can classify but the triggers then he asked me why this happens I said here is the external problem I'm here I may not flare up in the face of this problem but this one causes an inflammatory chemical cascade in me and connects something immunological that deregulates your brain and then you express to me the depressive picture now where you sensitize this is in your life story something in your life story the connection that

you connect of protection from helplessness to mother and all that for something, that's why in therapy you work on the triggers, it's not how to deal with these weaknesses, a cake recipe is individual, that's why I talk about psychology when I teach PR residents, right, about psychiatry, I talk about Psychology is much more difficult because it is individual, which is the fraction of extreme individuality, but every psychiatrist has to have this view because otherwise they won't help the psychologist, especially because there are people who don't see their trigger, how many times have I picked up

the phone and called Alex when he didn't even work with me In a different way I said, Look, I have the feeling that that patient is the batil, it's like that. Take a look at that. I have that feeling, so this has to be a thing. Sometimes the person says, there's nothing, and the person doesn't identify, I said D, super calm, my father and my mother, let's see this here, right, it's easier, so I have this feeling, it's because psychiatric disorders are syndromes, right, so in China, in India, the person became psychotic in India In

China there are cultural differences, obviously, but it's very similar, the way it's because it's deregulated in an area that produces light and the sensory perception is broken, the stimuli become strange and I hear the CBO hear a noise that wasn't produced externally or it creates a belief, a thought that wasn't It's real But it's for him and it's irremovable and there's no such thing as a Delirium or it's an upward or downward change in mood or it's fear, so this is a lot, it's a syndrome that recurs, we look for the syndrome a lot in

our diagnoses. but when I see an individual, I have to see the entire life story, it's an infinite checklist, there is still one thing you also have to see that the biochemistry of that moment influences, so I remember that in my protocol, the blood test always takes place. patients say, wow, but there are 12 tubes, I said. Well, I don't think so, because if I were to ask for everything there is, I'm asking for basic vitamins from the B complex, vitamin D, calcium, magn is the basic . it means nothing because you have anemia it

can be an infinite number of things then the person says wow but that's very difficult I said No it's really very difficult once we did a live like this in the past at Hospital das Clínicas the psychoeducational sessions were live in an auditorium where there was a maximum of 300 people today with Live you end up with 500 you have no idea how you get there, right video that reaches 500,000 you say oh my God, that's right That's how I convinced the older ones a little that it wasn't no it was charlatanism and it was

ok to do it on the internet but we were once doing a live psychoeducational session and then there is a psychologist who is from there and who knows what good psychologists know, she said and she needs the tests to make a psychiatric diagnosis, I eat psychologist, I won't be able to make a diagnosis because there may be other causes that are producing it and she said this precisely one week when a patient who was Elia in Mania had come to the outpatient clinic but the cause was a tumor in the brain of the temporal lobe

and he didn't have it. family history can happen, right And those who don't know about it say My God What do you mean, what do you mean, that's what I'm talking about in Psychiatry, I always put one thing in, my diagnosis has to be exclusionary, I have to remove everything in principle for it to be exclusionary because a Psychosis can be due to an alteration in urea, it can be due to an alteration of enzymes moment and people saying Oh but I'm sending this to the Clinician but he's going to get to you what are

you going to do The guy is crazy you see he's all altered I'm going to send it to the Clinician I'm going to send it to the specialist but I have to do something immediately it's on fire I refuse to take a fire extinguisher and try Okay then he'll redo the wiring and the worst thing is sometimes once in the hospital where I also worked in the ward a Psychotic was hospitalized for 30 days and When admitted, they always asked for neuroimaging, MRI and tests and so on, but serology takes a long time to be

ready, so the person saw the quickest tests and they completely forgot about serology after 30 days, a resistant condition that doesn't evolve, that does n't evolve, let's ask again Let's make a table so we can compare hha we're going to make a table Oops, this was missing here for the love of God, my daughter, she has tertiary syphilis that is back and in my protocol there are always the ooo, the markers for numbers and people 10 years ago, now like this, but you ask for cifr, it's extinct, I said love, people aren't using it anymore,

exactly hepatitis, hepatitis C, you know, so saying that psychiatry only in the head is the biggest nonsense I've ever heard about in mine, it's the most specialized specialty. clinic is you have to know Clinic for the love of God the person Sometimes I remember that in my time the person said I'm going to do psychiatry I don't want to know about clinic I said so my love is going to the wrong place because at that time it was just psychoanalysis point people Ok nothing against it but it doesn't handle the complexity It doesn't matter we

are beings that we are people say like this you believe everything you said this is a personal issue We all have religion and such I'm not going to expose it just like politics no one exposes ISO but we are either we are disembodied or incarnated we are so we have an organ which is the brain og we can cbro command all the others how come I don't know about the other others, right I may not know how to deal with the details of the Specialist But I I have to know that there is something to

think about, identify it and share it with another colleague and then I remember that this psychologist was criticized a lot live there, right? At the time on the internet she would have been canceled I think it's a little better I think It's easier for us to avoid looking at live comments, it's much more difficult, you're saying that we psychologists have to be careful, so I said, yes, you have to be careful, yes, because it can even lead to a hysterical conversion crisis, the person can have a epilepsy, unfortunately, you can have it, you can't have

it, and it's okay, we're just talking about things that help each other, ex, mine, yours, not me, but these are absolute truths that college unfortunately passes on and creates a division between specialties because At one time it was like, you go to the psychiatrist, you 're crazy, you go to the psychologist, right? So, the psychiatrist was the bad one, the psychologist was the good one, mom and dad, right, mom and dad, and I would love for life to be like that and it is. It's funny when we get a patient who is a psychologist, you

notice sometimes the resistance resists with people, I said, I told him, hello, the most difficult patients are the psychologists in principle and the doctors too, because they think that res I remember when when I attended doctor and psychologist say so , let's let our guard down , you're in the position you could be. the photos we have here of Diego's books This was the first Diego This is already a second edition, right, of another depression and bipolar disorder complexity of affective illnesses I loved the complexity because there's no point in selling ease because it's very

complex and precisely the objective was written then with professor Alberto Ricardo Alberto Moreno, who is an expert in terms of humor, is the coordinator of the group, he researches a lot of depression and depressive disorders and all his nuan morena is very well known and his objective has always been to bring this notion that depression is a little box that can have a lot of things in there closed only on the cover that says the Chinese box when you open it you will see is it a predominant psychological factor is it a biological factor is

it a vitamin is it is a subtypes there seasonal psychotic typical melancholic What's up And that was and in simple language interesting when we wrote this book I asked my secretary at the time I said Read this here and you mark everything you didn't understand you R I had to rewrite almost the entire book So you did the same thing I did with one of my employees an employee of mine for years, she ended up retiring with me, and I gave her books to read and she said this, I understood everything here, but in this

part here, I said, it doesn't have to be clear, it's a And then we I rewrote everything because she said this topic and these things here. I said this here too. You don't need to make it easier for people to understand, right? You're writing a PR book for the teacher so you can present it at a conference where there will only be people who will understand. Or are you writing a book so that your patient understands what he is going through and can have the possibility of understanding? End of the day, that's where else .

present in our day in our day to day in our life much more than you read you will be scared Exactly because it's from the time you go to the store and the attendant treats you badly it's humor it's ol it affects you it affects you right angry it was rude With me, that's humor, humor is present all the time and good humor is great. When you go and feel how delicious that place is, it treats me super well. I love it there, I don't even really like the food in that restaurant, but I always

go there because of that woman who what sold the food was the food it wasn't the mood of the person's environment of all things when people talk like that, so and so has great energy, right ? It's humor when you say that, wow, what good energy, what a person, charisma, state of humor, the desire to talk to her, the spirit, state of spirit, exactly the exact state of humor, right, it's beautiful, that's how it changes us, right, there's one thing. I think it's very cool, you talked about the book, I think that when you write

you have to, of course, have the objective, you are writing for the general public so that they can have information, you have to be Generous, you cannot be rigid about what you are going to say if scientifically. run you have to pass on the information if you don't have this generosity to write to the general public then it's just vanity that's it I at least think this is your profile too Diego comes from this a lot because besides being a good doctor and studying and enjoying of the affective disorders disorder you have this thing of

being a teacher and I think you start to be a little more didactic with it uhum because I think we work in the residents group that you have to like it you have to like it because if you don't like it because sometimes I can be a great researcher but I can't pass it on to my student because for example we talk so many times about the same things we said here that there comes a time when it could get boring then it sucks to have to talk about this again, but you keep reinventing yourself

and also improving, you say, wow, there's this, I'm going to talk about this, talking about it individually for that patient, there comes a point where you get to that, right, for that patient, I have to bring that point of view to that one. patient, I think that's what makes the difference, you being didactic for your patient, but you teach the residents, right? And that's where I'm most challenged because psychiatry is the first thing we get into psychiatry, Ana, you know, at the end of R1 you you think you know everything and then you go to

retz and especially after you start in life you talk in practice God I don't know anything exactly and patients are little boxes sometimes very complex that the person doesn't tell you a lot of things then things go wrong and then you discover a whole little hidden box magic of knowing how to get out what he's hiding because when you start in psychiatry you don't talk like that but he didn't report it he didn't report it he won't report it he won't say 50% he will omit it isn't lying because the in the beginner talks like

that ah but he lied to me so no love He's been lying to him for a long time it's nothing personal against you, you who have to have the magic of little by little more about relationships a little bee that talks must have to start poking to see if there is that, then you start I remember that I always asked every patient, do you like what kind of film because that It's what affects you, like how the first Sea was, it's so complicated, right? The traffic, can you drive here ? magic the magic of psychiatry

is to take from the patient what he didn't say because he never lies to you he omits it's not because he didn't ask me exactly and sometimes he doesn't even imagine that it's something that I already have that's why I go saying this has nothing to do with this is normal TR and defines this is normal and this is not that and he says this but that is not what brought me here I remember when I always asked how the intestine is working there was a A very rude man later became a great friend and

he said, oh, why didn't I come here to talk about poop ? It's a pediatrician's thing , but psychiatrist and pediatrician, oh, we grow up once we had it, but the child is there and she sees the nutritionist. Is it influencing your diagnosis ? Right, I don't know what, look, she's not calm, do you know the diagnosis, no, no, she has an anxious condition, no, she has bipolar tension Type two bipolar Type two, no, but she has depression, I said depression and and she already told you about the other phases, she stabbed a boyfriend she

didn't tell me that I said she won't Tell me then he's going to give testosterone he's going to give Test he won't tell me that then we went and I talked and no magic dear isn't said that's it then you start to be a psychiatrist And then the doctors , the others , they don't understand this , how do you do it? that the boy is like now doctor I'm totally stabilized so control control right Like how the doctor is trained to be and I'm totally stabilized everything is ok my sleep I've already learned everything

you asked I've even brought here o sleep energy so here your appointment is ready you're going to have this appointment with ease Um, okay, thank you, let's talk about other things, you start to leave, okay, okay, he's irritated, he's irritated and I think he's aggressive, but we're going to see the boyfriend when he comes in, when the boyfriend He came in and started his face changed because he said it's not like that I'm not like that and violent with the guy inside the office like a program like family cases ex of course this happens a

lot a lot and then of course I'm very smart and we become in psychiatry So-and-so is finished, you 're great, no, he didn't really bring correct information, he got a little confused. Who am I to say, look ? You're going to put out the fire by putting gasoline, no, why do I behave quietly and everything's fine, but then when it stabilizes, you're going to bring about this moment. Can you remember that situation that happened? Did you see how irritability is something that is blind to the point where we don't realize it sometimes and you saw

how it affects our behavior in that situation you were here a little excited I was dominated no you were dominated Do you remember Doctor I was and I wasn't really noticing but If you spoke at that time I would leave and never come back here again, ex, that's subtlety, I think it's beautiful because I think that this Magic of psychiatry of you seeing what isn't said and of you having this affection of searching there without attacking without attacking, you often even use your own examples of what you think the patient is doing, he doesn't admit

it, I said, but I've been very stupid at certain times, rude, you have to normalize the situation, people, if we were in a place, I'm going to be judged here I'm going to say that I never got into a fight at the supermarket, but if she told me, I've also said that, of course, this has happened to me with you, Bia, I said, don't fight, exactly. Yes, and he realizes that the disorder happens in all humans, as we all are, and how can they have it? They love to ask me, do you have bipolar disorder,

right ? And then I say, look, a diagnosis is as intimate as a gynecological problem, most of the patients are women, right, there's no need for you to explain to someone how important it is to know if you're dying now, here in the consultation with me, it's of the least relevance. this is here for me and on the contrary, knowing that a person has a disorder can even influence them to stop seeing the whole of you that you are much more than your disorder because I stay focused Ah, she is bipolar, let me keep an

eye on it because the Ana Wow, it's better to be a little smart because I don't know the prejudices and fantasies that others have about this topic exactly so I don't have access to it. Sometimes he thinks he's a psychopath who 's a murderer who's a monster so I tell them Sometimes you don't talk at work, you only talk to extremely intimate people, you don't need to get up, there's a military need, you're going to work with this, if you're really going to set up a company, an NGO, this will be part of your business,

OK now, otherwise you'll just look at the person will be Ah, but Alex, I think he's, you know, bipolar, so maybe you have to let that go, sometimes he's irritated, just today, it's not an episode, it's really cool because even that, right? For example, like you, the mood has This is this spectrum, we all have moments of irritability, anger, lack of control, talking a little more about the disorders, the difference is not qualitative and qualitative, we can have several things, it is quantitative and recurring throughout life, what I tell them F quantity recurrence so-and-so remember

that from time to time you get back together, you're kind of wanting to jump the fence in your ex relationship exactly But that's not the problem because I'm the one who sometimes gets discouraged, this interpretation sometimes I say is Subtle, it's from within, ex, you have no idea How dangerous these things are, the moment you realize that no, you're flirting, it's gone, you're texting, you're sending a nude photo of yourself, be careful, be afraid of your disorder, in quotation marks, respect, respect him because he's capable of doing things to you, he's rude another book, this

one that you brought as a gift, I loved it, I was already going to buy this one, it is the clinical cases in bipolar disorder, this is the book that kept me sane during the pandemic in 2020, because I stayed there focused because I could n't. do nothing, there was still no history of Lives, Instagram was just starting and I said, my God, we have to do something, do something useful, and then he will sit down to write the cases, Professor Ricardo, who is always with me, kindly read everything, scored a lot of things then

and then it was in a certain way shelved there for a few months because we know that publishing in Brazil Sometimes a big book like that You have a certain difficulty but after the pandemic It passed and the publishers kind of said no now I think that has improved We will be back We will be back, right the world will go back to normal apparently then they published it So this is the first edition This is a book fundamental for psychiatry students, medicine psychology also because he talks about the medication part But you take that

away and look more PR for neuroscience people, I think it's fundamental, fundamental for everyone in the health sector, I think it's fundamental, from the patient's history to the prescriptions. com and what time exactly I was looking here now at like 7 pm carbolit o why the por de cas is fantastic very fantastic No and the most difficult thing is often that you turn this into the book Without exposing people because you can't get the story of person, so you have to take it, dry it And you have to even be a bit of a literary

author Because it says so, history is that, the body, but this here cannot be changed, so instead of being a newspaper analyst, you will be a lawyer instead of It will always be like this, I even changed sex, sometimes I changed sex, I changed everything the State has to do because you have to preserve the people, but at the same time the students look and talk to the residents, I have taken courses on the internet also in these areas. They actually say it's a real case, you can know that it's a real case, not the

cutest one, it's when the patient, this happened a lot to me, we get restless, in the case of borderline dogs, they're too hot, it's because I started putting cases in there, right? Some people who called me said it was strange that I thought that story was so similar to mine, but I'm not a woman, I'm not an architect . one day it arrived like this, tell me because I'm so proud to be there in the book, it's really great, right ? based on you it's not you it's based on you No and sometimes when I

do Live then the following week my secretary already knows right why here it comes Oh I want to make an appointment I want to make an appointment Calm down, it's not like that he just has a new house per month it's very difficult then the person comes and says you said exactly what I have as I say because people have exactly the same things this is so true, right in form, right? It makes the other person identify a lot, this is fundamental, otherwise without identification There's no, there's this generosity, this openness, right, and it's so

cool because it's through this similarity that we produce empathy, it's possible And even when I don't have bipolar disorder and you go through a moment of irritability You say Wow, imagine that in a person cube , so it's possible, it's possible to put yourself in anyone's shoes because we have humanities that in the other are exacerbated. There was a patient in mine who for a few months she didn't accept the diagnosis of bipolar trans, it can AC even though I was teaching in the consultation even though I gave the book I gave the book F

needing to buy it here you will take it Read and see and say there wasn't this there wasn't that but always in that story of It's because I was like this and because and so and I say good but it's recurring to throughout her life, anyway, it was through my Instagram that one day she arrived and said I have a bipolar diagnosis and now I'm well resolved with that. I said hmm, that's great in therapy, you talked and she said, wasn't it because several people I saw They started writing reports there that were exactly the

same, but we're not, I say that the truth is always true, I've seen people, if you're into the enneagram guy, that I once went to study out of curiosity, he talks about personalities that fit into various patterns, I I said people , it's there, it's there, it's in the cabal, it's here, it's in scientific study, they're people because they're people based on people , right? The patient's mother is now very fashionable, right? We're seeing bipolar TDH and everything looks like you're creating and creating something. the Psychotic in the asylum no one ever saw autism wow

spectrum land how many children were isolated from society until they died quietly what a shame PR fam Wow for love then I think that ignorance was already greater and I think that when we bring knowledge the light is uncomfortable at first, right? I think it's normal because it's easier to stay with things that aren't like that, that's not how I think, the same if now someone comes and talks like that, bipolar trans It's not, it's based on Genetics, it's the exam, you 're not going to do the consultation anymore, the diagnosis, that's how I'm going

to say, wow, I'm bothered Ah, I would have done it another way. Exactly the norm, it's a life, a career. to look and see what is the basis of there, right? Inc It's the same, there's just enough time, give my love, forv one one one one one time a patient arrived and said this She read the book and everything has a story in the family of suicide such and such She researched no one had anything then after two years she arrives you won't believe it Doctor I found out that my grandmother's sister committed suicide but

my grandmother always thought that in fact she hadn't committed suicide she thought it was a heartbreak she took the poison disillusionment ISS not the phrase she used was she actually did self-extermination because she took a poison and she died so it was a suicide but a disappointment but in the grandmother's head when she asks about suicide there is even that, it's important, right the words that the We use it for things, no, there isn't, in reality, no, it's not much more, but someone took your life, whether out of disillusionment, then you already have to ask

someone else Man, exactly, Let's go to the pipim reporter, let's go, my dear, this moment, now we have a community called being human support are people who like knowledge, no matter their profession or who have studied They are interested in business And then 15 days before you come here we present your profile and they go there but we ask them not to follow you, right? to continue after the episode and there They delve a little into their knowledge and then they ask questions and then it's a moment where here on the podcast we give life

to these people to answer questions with you, okay, we can, so we should, first, what's the main difference between bipolar disorder, type one and type two and how each of them is treated, so we talked a little here, right, type one, all bipolar disorders will have recurrent depression, so the person will have depression plus another if they It doesn't stay if she is not treated, she will have the new episode and will have the new one and will have the new one and will have the new one. Above, it is very clear that it is

an episode of mania, which is an episode, a crisis where the person has a change in behavior that is completely different from what they were, so this does not make the diagnosis difficult because it is very obvious to the family that the person is having an outbreak, it is usually psychotic also then the person has delusions hallucinations So this is generally of greatness this of religious power I am still God God speaks to me I heal people this type of thing treats it and well type two the person will actually have a diagnostic delay of

15 to 20 years it seems that time is decreasing because it is getting better to think about this possibility because like one he has recurrent episodes of depression if she only the episodes of the upper phase They are very chronic and subtle that they even seem like only an expansive and pic personality like many of us are but we don't have depressions depressions right when the person has this phase and with these symptoms attenuated and And remember that these symptoms are not only of euphoria of positive mood but also of aggressive irritability It's not just

that irritability of the depressed person that is I'm boring close the door Turn off the light it 's not hate it's anger it's verbal aggression generally or physical too so in Type Two you have this between depressions and as you can imagine in Type Two it will end receiving depressives because we often don't ask how the person is and was before between episodes of depression, right, but the treatment must always prevent the upper Pole from occurring in both subtypes, so in type one because I don't want that exuberant Mania and I If I don't have

exuberant mania, I won't have depression because it's like this, it's a wave that goes up and down that goes up and down, in Type Two, what is it? the problem is that the person has a lot of depression, a lot of severe depression and so on and she even talks about it. No really, I have a little bit of high stuff, but it's very little, very mild, yes, regardless of whether it's little or mild, you can't have any of that. you have to have stability So we have to convince the person it has to be

a line it has to be a deadline that line can't be like that it's because you don't want to not have the next depression That's all we're doing But give me an antidepressant, no, you have to have stability, you have to disappear with these symptoms from the top pole then if eventually you have depressive symptoms left but the top pole is totally stabilized then you can use it because you are balanced you will have a medicine protecting you and following through, right? So there's drug treatment and psychotherapy that we talked about here, too, so she

can identify the triggers . lamotrigine and she goes on with her life, her mother dies, a lot of things happen, she continues without having new episodes, it's a more stable disease uhum, although the crisis is very Broad at the top, it's stable in Type two, the person is more sensitive to stressors, everything gives a a certain amount of movement and then it deregulates and then you have to see therapy to find out if we're not going to run away from these stressors If it's possible, sometimes it's not and or we're also going to Observe if

this is an episode or if it's a short thing that will last a short time or If not, now it's deregulated again and you'll have to change it again. Interesting, you're saying that type one, in general, it deregulates if it takes out the carbolite or the stabilizer, forget, I don't know what you, that you see being born, right next Bru Which ones these are the main differences between Mania and hypomania and how each of them can impact the treatment of bipolar disorder so these are interesting because sometimes people think Oh I have Mania But remember

that touch thing, right? Cleanliness is not good, but he but you know that in the Greek term and he came from madness so it kind of makes sense that mania mania that there because of the Greek origin of the Greek word, right So this madness thing there made a little sense They chose that term but for us it's activation, it's an increase in energy, whether it's mood, energy, impulses and thought, quantity of thought, because that's also horrible when a person's mind is agitated , right? The mother is speed, you know, and sometimes she doesn't notice,

right? Once a boy was hospitalized, I, uh, so I said, are you realizing that you're not, don't leave, you're talking too fast, he's not, I'm saying exactly the same as I've always said, no, no, don't leave. It's literal, you can't understand it, it's a derailed train, it is and the person doesn't realize it and it is and the word IPO means mild, right, but when you look at it like that it seems easy . so the person lives like that Tom dentistry and then she says no but I'm kind of sexy I really like showing

my chest I like ISS it's a bit of disinhibition Oh I'm kind of saying to people's faces what I think about they this is a bit of aggressiveness exactly like and and there are people who see it as Oh because I'm authentic I'm authentic That's not quite like that, right or I'm true Oh I can't tell why I'm true and how many people move away from you Because you are like that, then there is harm, so ISO, hypomania also causes harm, in the past people said Mania brings harm, hypomania does not bring harm, hypomania does

not bring harm in most areas, but it will live with the person so you can see what it is like will be the person's friend so you can see what it is like, it causes harm, yes, otherwise it's not a disease, folks, CL, of course, otherwise it's not a dysfunction, it's just that when you compare the magnitude of being hospitalized in Mania because you had a Psychotic break, you thought you were the God of Egypt really, but I usually joke that in Mania I throw gasoline and burn the entire sofa at once, right Mania, I

come with a cigarette butt here and you don't realize I'm burning it all your exact sofa in a year when you'll see it you'll have to throw it away because the whole sofa was burnt it makes it more visible quantity of perfect little holes next operation Bru What precautions should be taken when prescribing medication to patients who have impulsively attempted suicide Hmm then This is interesting because a lot of people have known about the mixed states of someone who is aggressive, irritable with increased energy with an increased sense of reason because the person who is

aggressive thinks they are right That is why they are fighting, the symptoms they always come together and the person's head is 1 at that moment when they are there in that Fury which is the mixed mania which is not that Mania with everything up, including a happy mood, right a mania with a negative mood along with the mania but in the Pole here in depression Not always me I'm going to have a depression with no energy where I face up and say Hmm, she's depressed, she doesn't speak, she lies down all the time, she smells

bad, she can't think of what she's going to say, and I can't even understand why she's so slow to say this. it is a pure depression in mixed depression the individual has energy along with the depression and the big problem is that this energy exacerbates the depression it pours gasoline into the depression what is it when I mix depression which is a negative emotional sensation that is distinct of sadness because there is no reason, it is a feeling that it is there that is unjustifiable for me and together with energy I have agony I feel

despair and then I want to get rid of that feeling, so generally impulsive suicide attempts arise in states mixed because the person is at the same time very depressed but also very energized, you know, it's different from the elderly person's planned suicide attempt, for example, the person is actually in bed, he has no energy, but he's thinking, my life doesn't make sense, I don't have it anymore Where can my family go? I'm a burden on everyone, it's going to be better. He's almost deliriously convinced that if he does that, it's going to be great for

everyone. later we can talk about it, it's horrible, right, but an impulsive suicide attempt usually arises out of this desperation, it's an impulse, just like if I took a lot of medicine to alleviate it or took a lot of alcohol so I could get rid of that feeling or even some People masturbate to alleviate the feeling of anguish or buy, sometimes people think that shopping is just because I'm happy, there are people who go after the brain, people try to reconnect in every way, get back into the game, survive, so we have to take Be

very careful because this patient has to be stabilized. Before he is, if I give him some energy with the antidepressant, I can uncap this impulse that will channel pushing him off the tightrope of the cliff he was on. That last little push is very important, I brought it today In the episode, something that I have been working on for a long time, in fact, I think I met Ana more when I started working with eating disorders, then we came together and our friendship grew and I work a lot with patients who undergo bariatric surgery, which

is one of the biggest concerns. and my main speech at congress is always this because sometimes the surgeon himself has that thing of wanting the report, which is really very important, but it's much more than that, it's the post-operative period of this patient that we have reinforce and keep marking up there because I see this patient turning around very quickly after a month, two months of surgery Because it's only the brain that eats, it's not the stomach, the intestine, it's the brain, if the brain has a deregulation that generates impulse, this impulse It's there, it

could be food, it could be spent on sex, it happened to a recent patient She didn't, she did it without my consent, I said, I'm not ready to do this to get rid of it, but I want it Pudo because also the person with accelerated thoughts She sometimes becomes obsessed with something I'm going to go because it's going to solve my whole life, it's not going to solve it, it's not just that, it's magical too and then she went and had the surgery and then came back the husband, you attend to her again, all because

she is very sexualized and it's very, very difficult, I've already had a patient take away the food, it was PR for sex because people get a lot of food, right, if food, everything brings pleasure, people get very involved in this thing. giving up food and going for alcohol is a more common one, but I've had patients like that from a life like that, from a life like that, from a life like that, from a religious practice, from a practice that's going to a bus stop, at that time, we had those bus stops. It's been around

10 years since the Zinha cabin on the bus was there and that dispatcher was there, right the dispatcher, this thing about going to have sex with these people because it is and it's a n as a way of relieving the person, that's why before They said it was spiritual because it really works, it's very similar to things because it seems like the person is taken over by something else, but our head can make us want to flirt and send it away, Ah, but now I've lost weight, I'm super pretty, and now I I can and

once a patient went, her two daughters came and said Doctor, we have a very serious problem because mom is very sexualized, she impulsively ended a marriage with my father and then she is seeing new boys paying by giving them money and the big problem with that the psychologist is telling her that female empowerment you have never enjoyed before you deserve to have sex and there is this there is this situation you can ex But let's look at this person's life story she was never that exact because if it was something that she always changed, but

now that's why it has to be a joint effort And the psychologist has to study a lot, I know it's boring today, today I'm in a boring team, right, until the person doesn't understand, right? people who criticize even the surgeon I work with today but he doesn't give up having to be the team's psychologist or being the team's nutritionist because Why are you there and help to minimize these possibilities? See, now I'm a surgeon, aren't you? I don't have contact with you at the psychologist you want, I don't know you, but it's because they don't

understand the seriousness of what we're talking about here, I know you because I had surgery, I was in the surgery league for many years, I know how they think. They think that psychiatry is chat, it's exactly chat, calm her down, she's chattering today, go there, go there and calm her down, go there and talk to her so much that production thing they called it psychiatry because the person's relative died call psychiatry to go there, he said, but actually that's not the case, that's not the case, that's another type of thing, right? That's why I agreed

to stay in the third year of my medical degree, which is kind of boring in class, but because we have to teach people what psychiatry is because they don't know, they think it's something, you know, the complexity of beauty, which is what it is, the complexity in all areas, if your dermatological patient has a disorder, he becomes obsessed, he starts doing a lot of a procedure that screws up his face, we have a lot of examples in the media of people that happen exactly where you see impulsiveness People, for the love of God, the person

put a product on, then I don't know what, and then everyone sees it and they can't do nothing because I'm not the person's family either, right ? for this stage it's because otherwise it's just a thing of influencers who put things that you see as pathological, you say like this, people, this person is out of the little house and then you'll see influencing people as if that were empowerment That's not empowerment, there's this idea that mental illness can affect anyone, it's also no wonder, it's no wonder that I'm always very aware that the suicide rate

among influences is skyrocketing because they are people who can have a mental disorder like any of us, anyone among priests and pastors, we also didn't talk about religious impulsiveness here. But that's what I sometimes talk about in the office, look, remember this one? period here when you became totally religious at the church of Canto and tananã tananã and went out to preach, no doctor No, it's not possible that this was talking about It's also Look at your life story, you stayed here, you only talked about that, you stayed put, you didn't stay aggressive with people

who didn't think like you exactly have a lot and then you talk about it it's almost a taboo Because you talk like that, not with God, not like that, I'm not talking about God, I'm talking about people who have brains who can have mental disorders within the church and then there will also be suicide because they are very religious people Elber it can also be committed due to depression, if it is a serious depression like there are some that have happened, they will end up on a bed and the disease will say I exist, I

am here exactly you can pray as much as you want there is religion there is God can but look but don't belittle don't belittle your organism exactly perfect next Bru am I what is dysthymia and how is it different from major depression What are the treatments available so we even We talked a little about this, right, the symptoms are milder, they are chronic and you can spend years chronic sadness thinking that this gives you a sadness that is a little exacerbated, right, exacerbated together with pessimism with hopelessness, a grumpiness, annoying, lower energy, more social isolation.

all the symptoms of an episode of hatred for someone who has major depression, which is when they have a more complex and intense condition that actually causes significant damage, the person stops working due to major depression, but I, I, this is in the first chapter in this book and in the other chapter is how much the milder conditions I consider even more dangerous because a psychotic mania, if I have it, my mother will know that I have it, my father will know, let's take medicine for the love of God, he I was crazy uhm that

's not normal now that family member who lives and doesn't move forward because it's a prolonged depression and doesn't work and doesn't have energy doesn't socialize and it's boring to talk to him and stuff, people will say that's the way from him pum stampi it's over bye next time so this is terrible because you take away the possibility of better now you seal the future Uhum So eh So that would be dysthymia it is when the person has symptoms at the extreme of depression in a much milder more chronic intensity chronic and that this can

even be worse because there is an article that talks a lot about this, right, which is worse major depression or subsyndico depression, right ? to be lived let it be is metaphorically, right, I understand philosophically existentially philosophically you have ceased to exist, right, everything that could have been and wasn't Whoever said that exactly misses what could have been and wasn't, I don't remember, but I think the march of Assisi maybe I don't know it was an author who talked about everything that could have been and that it wasn't that it wasn't it's beautiful it 's

strong of self-harm and what are the best ways to help someone who is self-harming, self-harm can have many causes. Surely then I can cut myself because I'm Ana's son and she doesn't pay attention to me, she just works and I've already tried of everything, I've already made a drawing, I've painted a picture, I've already danced chachado and she didn't and she didn't play hello and of course some teenagers will do that and we shouldn't judge because ours, our reaction is always what nonsense you're going to call attention like this, yes, the brain, when it doesn't

have the capacity to understand, it will do what it can, yes, and as a teenager, it will do this sometimes, and many professionals judge this, even like, oh, PR, to draw attention, how terrible it is for getting attention is very serious, it's a disorder, so there's no judgment about it, quite the opposite, it's very serious, you have to get to that point to get attention from another cza, but it can also happen, like to alleviate mixed depression, too, so the person just has to, sometimes It's hidden because I don't want anyone to know because I

know they They're going to think I'm an idiot for doing this because I'm an adult and I'm doing this burning my leg, but I did it once and I noticed it eased And then I go back and repeat it several times, people aren't stupid like I saw on Instagram that they send me so many things that I say, people don't send them to me because I get angry, I get angrier because it's so much nonsense It would be better if I hadn't seen this, right, but a professional psychiatrist writing there on his network and everything

right in the post that he gets a lot of anxious people and that these people are so stupid that they are spending money on him when in fact they should be they could alleviate it with a trip like this with a surreal trip then I I couldn't help it, I went to write, I said, you really don't think you're underestimating the intelligence of the people who are looking for you because no one San conscience goes to a psychiatrist because it's a crazy thing, he's going to get other help first if he has to go to

and person doesn't want to take medicine they want to take other things they want to exercise they want to try it people they've tried everything they're not stupid people have an intelligence you're underestimating the person's intelligence and overestimating yours when you say that because the person, CBA, he tries everything before, right? And if he does something and it works, he repeats it, he wants it again, that's the problem, right, with this little machine, right ? It's very shocking to see a teenager's leg completely cut off, but it caused relief from something much worse, even though

it's difficult, you have to try to amplify that. That 's your reading. When you look at that, it's horrible. Think about that multiplied by 10. Exactly because this happened once, including at Hospital das Clínicas, the girl being treated and so on , she went to the hospital bathroom and almost died because she really cut herself, my God, right? It's desperation, we also had patients who, with very serious self-mutilation, one almost got the carotid artery and we have to understand that sometimes, the more serious there is energy with this, people, this person, if you don't lower

that energy, if they had it completely, energy she was in bed yes no if you don't lower that energy you are giving a weapon weapon to the person throwing gasoline on the fire I like to use this metaphor because it is like that and look how when I throw gasoline on the fire it also burns me With I'm sure this is the worst thing because as a professional I'm doing exactly this and I'm being exposed to say that once, in the back of my head, this happened to a patient and so on and so on,

he was taking antidepressant treatment, his diagnosis wasn't bipolar at first, and he wasn't it was a mixed state at first until he violently attacked his wife criminal case arrested money involved lawyer that's how it was resolved sometime when he comes back and starts telling how he was, people said Look, you really were in a state, you turned around, you were in a mixed state produced because of the antidepressant and so on and now we're going to have to change here and we're going to follow a different line he said no, wait, are you trying to

say that the medicine you gave me caused this to me are you kidding me? I said yes, this one can happen. it's the gasoline that can come to me and I also feel burned, it can happen exactly because of this situation and that 's the difficulty of being a psychiatric person, people have no idea how much of a psychologist I can have a suicide on my back or a homicide that That's the case in this situation , right ? the signs that it is time to stop or adjust the medication This depends a lot because

you have to be monitored and there are people who will need to take antidepressants for the rest of their lives when depression is classic unipolar in the bipolar disorder the person has stabilized, i.e. in pure pure depression Have you tried stabilizers that cover more of the depressive pole such as lurasidone and lamotrigine nothing had no effect you will switch to antidepressants uhum It could be that they produce a mixed state you say no no You have to take it off. It may be okay when it gets better. The literature has said that we have to

keep it there for about 3 months and have the courage to take the medication off and the person cannot be afraid and has to understand that in bipolar disorder the things are different, things are different, so sometimes I take the person to another level, he stays there, he takes the medication and everything will be fine. It's just that the plane changed lanes to vibrate, but our instinct is sometimes It's a bad thing because we're also scared as professionals, because I don't want to cause her depression because she's super functional, exactly, but we have to explain

a lot to the patient too, because sometimes keeping the antidepressant for a long time isn't cool. you can play stabilization to stabilize and remember the treatments that are non-pharmacological so, right, when you really don't have it you will have it you will resort to it there are possibilities of treatment with camine with electroconvulsive therapy transcranial magnetic stimulation direct current electrical stimulation TDS exactly eee which are things It's great that there are a lot of things coming to help us there and it helps a lot Wow, even more will definitely come next Bru, is it safe

to use antidepressants during pregnancy I'm going to switch to stabilizing antidepressants during pregnancy because people are sometimes very afraid of medication during pregnancy Ok, of course we have to be afraid but we have to remember that we live in a huge world where a lot of people are being treated all over the world And we have this data to make us safer, which is good and what is not, in fact, what was shown to be unsafe was paroxetine in pregnancy in terms of antidepressants and what was shown to be unsafe in terms of stabilizers is

valproic acid and carbamazepine, lithium, it was talked about a lot In the past, it was dangerous every time but the studies have shown that this lio is compensated, because it is one in 10,000 pregnancies, you have an issue that is not even malformation, it is a mild thing. Sometimes the benefit is greater than the risk, right, but people sometimes They don't think about how much a depressed mother can do a lot of harm to her child or kill her own child, I've already had it popal in a serious case of hitting the belly, I remember,

I was also once a patient admitted to a university hospital and she was a user of pregnant crack. Then, about 25 weeks later, there was a big belly and it had to be contained because she said I'm going to keep beating it until it comes out, so hey, you have to leave the person tied up because if you don't do that, they're going to kill that child, right? People have no idea how serious it is, how serious it is, why doesn't it show up? I also remember at the beginning that I went through a situation

where I was prescribed an antidepressant for anxiety, a tense tag of generalized anxiety, and the obstetrician turned around and said no. you are not going to take this medicine because this will end up your baby will be born malformed, this cannot be used during pregnancy, training I said don't give me her phone number I will get in touch because you have Panic, it is serious, you try, Cardia, you it increases your blood pressure at the time of crisis, this can cause you to have a miscarriage, ass bleeding, here's the literature, let me talk to her

because I'm the one taking responsibility for this because I know that the consequences of not taking it will be much worse for us. There is no data that leads to harm from this medicine, the professional didn't accept it, didn't even want to say it, no, I won't take it under any circumstances because she's my patient, I won't let her take it anyway, but of course she's a person of the decade a person over 80 is fine, but you know I think this has nothing to do with age because I see very young people being radically

possessive of patients and older people, we even have the case of a psychiatrist but he didn't know what magn stimulation was we are doing to the patient he is completely open to the sea he said I can send it I can send it you know so there are cool things it's the point of view I think it's the point of view it's the ego this thing about saying the patient is mine the patient is mine I'm not Don, people the owner Imagine we want the patient to be well and you have to work that's why

you have to go to therapy, right because if you discover that you are like that you have What to say Oops, you're being iatrogenic with your patient, we have a case that this month we 're going to be Gabriel's grandpa, who was and the name was Ana who said that, right? Ana was still providing support, there wasn't yet totally closed to a girl who wanted to get pregnant and she had great difficulty, she breastfed, she took medicine, Gabriel is being born, wonderful, are you sure , isn't it? But it could be that psychiatry was the

panic attack, no one will ever be able to prove the value of psychiatry until in the future we will have exams, no, I don't think so either, but I think we have to see what the ace is also releases Mita but no no no this anxiety with panic that then told her no she won't take an antidepressant and everything I said she is having crisis after crisis there adrenaline color temp D abortion is escito abação And then they just no VM there was no So the day that the psychiatry advances a little further I will

show it This is my patient's brain here exactly So this one is even iatrogenic if you don't allow it to be done then you will have to take responsibility really based on nothing based on is because the patient is mine I decide mine is it's ego meso this is arrogance and ego It's close Bru how can contraceptives interfere with treatment with psychiatric medications there are interactions that I should be aware of so Eh in general especially for the Most people who don't have bipolar disorder but who have anxiety depression, antidepressants and tranquilizers won't make the

person at risk of pregnancy Wow, my God, I got pregnant because I was taking Flux Ketine or ven cleaning, right? to stabilizers in general also no lithium no valproic acid no carbamazepine she's the annoying one she's very arrogant and she doesn't get close to anyone exactly got close to her she puts it down here you won't grow no she lowers the level ce dictator carb she's very arrogant grandiose she is manic she is manic exactly you understand And she is antim manic also for others she antim she doesn't want it with her and then she

really drops and the person may be at risk of losing the effect of the contraceptive getting pregnant but in general the rest the others are sane calm, only carba masep magnetic stimulation can do in pregnant women ST stimulation that elet convulsive therapy can do in pregnant women it will help continuous being too so if someone indicated it can do neur feedback you can also when there is an indication, right It should when there is an indication it should next Bru can I consume alcohol while taking medication this one is classic what are the risks This

one is classic and this one too I've already answered so much that I've even saved the answer let me get it, it's already on automatic let me get it here, first thing folks, if you're in crisis If your hand was cut, would you pour alcohol on your cut hand? Of course not, because it would burn a lot. So when you have symptoms, you shouldn't drink alcohol. That's the independent question, what is the medicine? I don't want to know. the medicine you are having anxiety you are having depression you are having irritability zero impulsivity because you

will make it difficult to stabilize those symptoms or amplify or deregulate exactly okay so this is a first point then enters the point of interaction of Fact, right of interaction of fact is more complicated with the sedative medicines so clon zepan alprazolan go stagg pretas and also the op piden who are our little friends who arrived more recently, you know, like those who don't want anything but who want everything yes yes Total but now now Now they've already put him in the room where he should he was he already because people drank it with zo

opid in a way, but it's not taja preta, you gave me another recipe and so on, exactly, so those that are like that, ok, right, and in the others, there won't be people TM, it's more of a certain collective delusion that you You're taking antibiotics so you can't drink alcohol You're taking psychiatric medication, not because what I always say, once a patient who had a serious alcohol problem and also had a mood disorder, hey, he, his wife said so, Doctor, I'll tell you he he's taking pills and he's drinking alcohol Then I tell him he

continues taking pills until we see if this miraculously works for him to stop drinking alcohol afterwards because if it doesn't it won't be anything nothing nothing prefo in this case I am we are walking Of course I want to reach Atinense, we're going to work towards that, we're going to do the therapy, but don't use the medicine, don't use the medicine, it's going to be worse, that's the harm reduction, and in this medicine, which is calm, it's a proc nasal stabilizer. There are big problems here and So, So it's much more a Sometimes people have

a bit of fallacies in this area of ​​alcohol, right, nothing can and such, but I think it always has to start from that point, the person's sensitivity too, right There are people who They drink and get depressed, right, depressed the next day I tell them they get more anxious the next day so don't go so I tell them now that you've stabilized you're going to try to have a normal life with normal alcohol, it's not stuffing yourself, isn't it? getting drunk isn't that what happened I got depressed afterwards so you can't it's nothing in your

case you saw you noticed you have to be sincere, right you have to be sincere next Bru how to differentiate depression in bipolar disorder and borderline personality disorder Especially when Someone is diagnosed with both, right, this question is always also borderline bipolar, right, borderline disorder and I, and so I even publicly thank the book because many patients can only understand borderline disorder after reading books where they are very clear about the issue of the disorder. Borderline is an emotional relationship of attachment with another and the fear of abandonment from the other. That's what moves it,

but it changes mood. The person is completely normal, but the moment the boyfriend stops responding, then he becomes unstable. of rejection is a lot of emotional dysregulation dysregulation is not a change in mood out of nowhere that she wakes up ISO and I'm out of patience I'm rude to the employee I'm rude to the doorman I'm rude to my secretary I'm rude to a co-worker is It's different, everything is normal, but you see there's someone related to someone with whom she has a very strong relationship, it could be her mother, it could be a girlfriend,

her boyfriend, it could be her husband, but it's closely associated with her son , right, there's this thing that's so reactive, so immediate. perfect Fantastic next Bru in which cases of disorders is treatment with magnetic stimulation indicated? That's very good . global guidelines already as a very very good treatment this is no longer discussed ISO, for the love of God, there is no colleague who says it Ah, but I don't know that, it's not discussed. They saw that the waves arrive in the cortex at the beginning of the brain, but people, the brain is all

connected, it's the same way, it has a partner who communicates and speaks down there and who says here that he talks there, he does it here, we don't need anything, what do you do it in the cortex, it reaches the movement of your foot, how come it doesn't reach the parts? So people think it has to reach the super cortical cortex in the subcortical area because there are limbic areas and such connected, calm people, it's not like that, it's the medicines, we changed the way of understanding medications and magnetic stimulation was first shown clinically, then

they understood and saw that it was the interconnections of neural networks and that it had been all along, right, in bipolar disorder, the samples were mixed samples, so they they put a lot of classic depression, so there are very few studies just on bipolar people and we are now doing one with 60 people with bipolar disorder type one, we started with this subtype first And then it's good for people to know How much work it takes to do research because we've been there 2 and a half years to recruit 60 people who fit into the

caib that yes, they are not using the crack now that they are not drinking alcohol now that they do not have an associated personality transducer to clean up other variables a little to see if it has an effect, right, but then we will see the result of type one that you are looking for later will also have a study of type two, which is something else, also something else because to give you an idea, we did it before, we even skipped a bit of a step there, but at the time it was my doctorate and

I I wanted to do this magnetic stimulation in mixed states uhum it got worse because it is an antidepressant but you did it in F3 and we did it in type one type two and unipolar depression too but everything in F3 all stimulatory all stimulatory no no no no no I lie I lie I lie she went and on the right it was inhibitory and it was excitatory on the left we agreed, nothing worked on supplementing the motor, no, it was just F4, F3, that's it because that's what we had until then, we needed it,

why not, and that way, if you do something very different, we sound Third world country , when they look at our studies, which are you, my dear ones, no one has done anything and you are wanting, so we have to very much replicate what is already going on and open up a little so that someone can read that study and then accept it. right, unfortunately, what she showed is an antidepressant. She is cited. So, if the patient has activated, then with very strong suicidal ideation, he tried to commit suicide last week or with very strong

Automation, then at least this modality has to be used because when we talk about magnetic stimulation, it is also what you said No, it's not the same thing which stimulation you did is inhibitory this inhibitory this was inhibitory on the right and this was inhibitory on the left So but still but still she wasn't she she It got worse It got worse and it's funny that in the study that we were monitoring the patients, some of them are getting better, some of them are getting worse, people are going to do well, they're going to do

well because some of the things are getting better and it's the patients who are receiving active therapy, all the time the double blind opens, the patients who were receiving it were getting worse due to the stimulation and those who didn't receive it were improving spontaneously, right? So, research is what it is, it's what appears, it's what it is, you don't have to change it, it's interesting, right? We've already done it on some patients who didn't respond to anything medicated, but we only worked on F4 just inhibiting uhum it was exact It's perfect because we really

have F3 we can unify it and It can of course you have a risk of a manic turn in your studies Yeah and it's a level one antidepressant exactly it's an antidepressant it 's not an antidepressant exactly F3 no Yes, but our hypothesis was that it was Bruno, at the beginning he said this: I think it must be a mood stabilizer because the risk of suicide did not increase in the studies, I said, but patients see it without the risk of suicide, it always removes the risk of suicide. It's a real-life sample, you really have

to do the research and then he said let's do it And then it gave results when the result came out he said we're not going to publish it anywhere But in the end we managed to publish it because the negative result of this amount is important to raise awareness also be careful with F3, right And get it right and perfect next ah, we arrived at a very special moment pipinho, our mascot, Dora Ana's son, he is, she tries to educate him as much as possible with good content, he is so much that he just listens,

don't let him F asso, he is not don't randomly watch that, my fil of that too And then he now enters this part to play with you a little, he generates some words, he also studied your content and then he generates a ping-pong where his mother will voice him and plays for you whatever comes into your head you you will see my unconscious jando sea Gabriela We are judging we are jando and he is so nice that he always leaves this message with me to tell the guest that if he doesn't want to answer just

say the word step step and everything is ok And everything is ok, ok combined, love my daughter Mariana Mariana do Because self-knowledge self-knowledge is not medicine because sometimes we don't learn everything as we should learn, you have to seek self-knowledge alone, always always and and a One time a colleague sent me a meme that was a dog holding its own collar and I told us at the residence because we are a lot like this, exactly, we have to look for it alone, right ? of a journey with no end S beginning, right And it gets

worse as you see that there are more forests for you but worse or maybe it will get better so we start to be dazzled, you know, with the complexity and also knowing there I'm not going exactly, I'm not going, I don't want to . works exactly three euthymia euthymia is something that sometimes patients always ask, right when am I going to be stable when am I going to be stable when am I going to be stable said Look at a stable person every day like you are Speaking of which, it doesn't exist, because everyone fluctuates

a little, every woman has PMS a little sometimes To a small degree Sometimes our life isn't the way we want it to be, it does have to affect your mood because it would be strange for you to stay still and happy and laughing and laughing like a teenager in teenagers have these moods like that, right, it's full of problems at home and the person laughing on the bus You say Wow, how funny are people like that, right? You'll see adolescence but the immature adult the immature brain But in adult life it fluctuates Okay but it

can't fluctuate to the point that it hinders you in your relationships to the point that it harms you from having your job to achieve your things so it's that level of euthymia, right? It's what it is live the normal waves of life without being the storms of the episodes perfect perfect surf your stability and continue living four if you could get into a time machine which moment would you choose to visit past or future future I'm not a person like that Oh how was it what was it it had to be it was good what

it had to be it was bad what it had to be and but it's not because the future is a possibility, right and the past is a certainty so So I think that's the way I would never imagine that I would be where I am in my profession today when I was there in the fifth grade, let's get it Never imagine, right, if you showed me I would say this is absurd, absurd, so this I think is what the future produces, right, this possibility that you don't even think it is possible possibility here how come

I 'm here today on a podcast that I see Ana I've always seen since I was doing a residency and on the networks and talking and I'm here today do I have the content to be here to bring this so but it's interesting because things are happening this way so healing is this this seed that we don't know what tree it will grow cool this five happiness happiness is so people I think they put it outside of themselves I think happiness is we have to give, those who live with people with depression are very grateful,

I am very grateful every day for something that people don't even imagine that I say, people, I could be living what this person is living and I'm not, I'm not I'm rich, I'm not a millionaire, I don't have a plane , I don't know, but there's no money to pay for that, sometimes I sit down with the person richer than you 20 times and they don't have what you have, internal calm, truth, it's true, there's no value to pay, so like that There really isn't true emotional well-being, right? I've seen people come up to me

and say I'll pay you whatever you want so you can get this off my chest, that's it, but whatever you want, I said, don't stop there, I'll do it. everything I can without you paying me anything other than my work has better that you I can guarantee it once someone said give me the most expensive medicine because I need it I want to use whatever it is I say look well and you don't always imagine a plant that has your characteristics and it only grew up to 1.5 m, you want it to be 2 m

tall, is that possible? No, so in biology, sometimes it's not possible to get where we want, I'm going do the ex you can be sure this doesn't go through giving me $000 or giving me D doesn't go through money these are things that we don't have access to how far we can go not through well-made medicine I've never seen anyone become a millionaire with well-made medicine I've never seen it, and people say Ah Bia, you say, I'm the simple person, I didn't do it, I didn't do it because it was never a value, never, and

you have a calm, peaceful life, and a lot of being, that's not worth paying, once, I was in trouble with my wife, we didn't have our daughter yet and she was there, next to a table like everyone, that noise in the restaurant, everyone was eating, there was someone like that, young, standing in depression, I was sure that that was depression, we see it and I was sure that That family thought that taking her to that place would improve M, it's not the opposite, it's disrespectful, disrespectful, it's like a person with cancer affected like that with

their hair all falling out, you ah, let's go to rock and re, let's go to rock and re with the noise of night you have cancer and look at people's ignorance, I understand even goodwill, but we have to understand that helping is not what she imagines, it's what the other person needs, it's not what I'm having, right? Why is that? what people do they want to use their psyche exactly to help the other, that's what the other needs, I know, complete the sentence Mental Health is Mental Health is Global health, everything is mental health, all

specialties will affect mental health, perfect, the dermatologist, the cardiologist, plastic how many people with serious problems are looking for, right, if I improve my hair, my breast implant, I 'll go, then I'll be happy, no, no, no, I might even open one more FR, eh, seven If you could choose a superpower, what would it be and why Ah I have access to thought because our profession if I had I would say it like this, you don't need to say anything uhum psychographing I even made a river, right? I do some kind of funny things there,

right? Because people send it to me like that . picture I said I have to sit here and do a mediumistic table because I don't know is it a woman or a man how old is it, what stressor did you experience, what was it like at school, bullying, abuse, what is your family history, substance use, people are much more complex, psychiatrist He's not a medicine passer, eight life's purpose is to teach because they gave it to me for free like that. People, you have no idea, like me, that there are other possibilities within the academy,

right, where are these vanities, right? It wasn't so the doors were closed, right, but it doesn't stick. Incredible as it may seem, people think Wow, but there are stars of mood disorders, there are people who have been treating this for 42 years, that's all, that's really me, so everything I asked to do I was able to do I want to do magnetic conation I think Ricardo Moreno has this, he is he doesn't have it like that, he doesn't have it, you know, when people are well resolved, they are not afraid because there is space for

everyone, people exactly to donate, right, donate, look, this is how it won't work. right, he's Panamanian so he said this isn't going to work and he teaches me he didn't need to do it I could I'm going to keep it no I know what's going to work fall so it was very much it was given to me so I feel a certain obligation to give it back because It was given to me for free, perfect out of generosity and you will generously repay it, I really miss it, right ? I want what you want, I'm

going to do what I want and she ended up, because she didn't use CPAP and she had very serious sleep apnea, she was having strokes oh my God, so today she has advanced dementia Because of these respective strokes and I miss her because the one who is today is no longer the same, I understand, you understand, so this is very much like you. I miss the smile of the life drive, right, the life of the life that inhabited her, right, the life drive is alive, but it's not alive. I understand it's not her anymore so

I miss you a lot as you said, I was thinking about school and so on and this came to me because you miss the person I think a person is also depressed, sometimes you miss how they were before they got depressed. Exactly exactly, they miss you, right, and the tenth sentence can be yours, it can be from any author that you or a thought don't need be a phrase made something that expresses itself, not me, I think so, I thank social networks for welcoming us as they do, right? I never imagined, right, on my page

it's super small, there are 170,000 people there, who are these people? idea of ​​who they are and they want to hear what is being said there, we have to be very grateful that people listen, right? Of course, we try to get as much as we can, but we listen to someone that you will never know I think that in some way you are influencing her life positively because knowledge will always influence positively once I read one in Direct one they send several reports I can't hear them all read them all but the boy said I

'm a delegate here in the north of the country and you're not You saved my wife's life, I said wow, you were patient, right, no, really, that's the thing, hey, I was going to kill her, I had already hired her because she was having fun cheating on me with a a lot of people here in the city and it's a small town It ruined my honor and then she was hospitalized she was diagnosed with bipolar disorder and I said nonsense, that's just because I want to have it now, like a lot of people do sometimes

when someone receives a diagnosis, right? doctor that was the issue of the baby that was stolen and there was a report with bipolar tension you see people writing they are not at all empathetic bullshit that's it now to escape from jail so it's easy people don't believe in the ex mental vice and he said it later I went to see its content and I saw it, I saw it, at first I didn't believe it, but then I went to see it, I said, she really has it there, and then I forgave it, I understood it,

and now we're together again, I told people that it was that case with that woman. who ended up in Brasília having sex with that beggar uhum it was clear that it was bipolar people criticizing her husband it was wonderful because he said my wife was sick and people were giving Ibope to that beggar who was totally characterless, I'm not saying why the beggar, not because he was already that It's the person, right, and the people, and I went to say this, the beggar started attacking me, I said, love, don't worry, I just know that she

was, uh, me, and she was upset, she was totally in a religious delusion, and you took advantage of her, pcom.br, the rest, tell me what whatever you want from me but don't shake me because I don't know but nowadays we are gaining strength nowadays there are people who write without you needing to be quiet you don't know what you're talking about it's a mental disorder depression does it matter bipolarity IMP as things are changing my dear I wanted to thank you so much let's close here our Cico was wonderful I hope I can still have

other opportunities oh happiness as a gift for you o it's neuro feedback in the ddh treatment which is Alex's depression and minds that love too much and have the little present there with even more present than I brought, calm down, hi, here's our little baby, okay, it's ecological with the saying, make it happen, inspire, you can kite, I went So here's the Mug, exactly Rock and re, I went, right, there's the notebook here for you put all your project possibilities you can put there now you will look at this camera here and give all your

messages you don't even need to look at us courses everything you where to find you your future projects that are in progress Vado that's it that's all You don't even need to look at us, no, great, it's the book, I think it's a book that interests everyone, depression and bipolar disorder, the complexity of affective illnesses, it's a simple book, calm language, if you have an affective illness, an affective disorder, depression or bipolar disorder or a family member will help a lot to understand, I also have courses, right, which I launch online for psychiatrists and psychologists,

on the diagnosis and management of bipolar disorder on the internet on my Instagram @d diegesis psychiatrist and there is also the channel on YouTube Diego Tavares psychiatrist has Diego Tavares psychiatrist on Facebook and we are everywhere Thank you for the invitation, we are grateful, look, I liked it, I felt bathed in knowledge, thank you very much, dear, we are finishing the Kite Dust Episode and today was wonderful with this psychiatrist that I already deeply admired seeing his work on the networks but that I had the pleasure of getting to know and it is even better

than what you are seeing on the networks which is Dr Diego Avares if you don't follow follow He will be appearing here on the networks social media so you can follow and we know that here in the pod pipo community we believe that knowledge, self-knowledge is the only real thing about empowering a human being, if you follow us, we continue to follow and propagate what we are putting out you don't follow follow start clicking the bell to receive all the news and if this content made sense to you pass on pass on to whoever you

think will benefit from the knowledge Thank you very much and see you in the next pod PIP