Inittornit

I always thought roulette (betting only on red/black) gave the house only like a 2% advantage, and is essentially a coin toss like baccarat, is this not true, or are you saying stay away from roulette in reference to betting a specific number?

Any thoughts on what this means on a practical level. I watched your video, agree with it, but throughout was wondering what that looks like. I am a psych NP in a NP friendly State, if I practice at the top of my training and license it looks essentially indistinguishable from physicians. I have less patients on my x-waiver, and I don't have admitting privileges but beyond that are two roles of a pmhnp and psychiatrist look the same here.

I know what I don't know, and know when I want that extra training of an MD or DO to weigh in on a case, but if I was that overly confident NP I have no outside force readily compelling to seek physician collaboration.

Also I like your insight about where the overlap is heavy then the physicians might be practicing at the bottom. I have started to see a shift in the physicians locally moving away from outpatient med management to more inpatient consultation, TMS, ECT, Ketamine, etc, now that NPs are more readily available for that outpatient role.

I would add that vortioxetine, vilazodone, and mirtazapine tend to all have less sexual side effects than the ssris and snris including the ones you mentioned. Wellbutrin and mirtazapine can be "antidotes" that can be added to other antidepressants to help resolve some of the side effects, or viagra, women can trial addyl or vyleesi for low sex drive sometimes we occasionally use cyproheptadine off label. If someone is having sexual side effects of antidepressants; low sex drive, loss of erection, delayed ejaculation, reduced tumescence, anorgasmia, vaginal dryness, etc. You need to talk to your prescriber, this is the most common reason people stop these medications and a lot can be done to help.

Not at work and don't have dsm handy, but should be in the conditions for further study. Also the DSM is much better thought of as descriptive not prescriptive, so if all other similar components exist as with other substances, then consider it a disorder