Thank you so much everyone for sharing your experiences. I have to mute notifications now due to virality but I've done my best to read and hear all of you. I'm glad my message resonated with so many. and pretty much 90% of disagreement/exception was respectful.

Thanks, all.
Honestly I'm touched, sometimes i feel this place is all about fights but most got what I was saying and shared so much about the *why* I've said it. If you ever want to see a "reaffirming ratio" look at that thread.

/2
I understand why parents feel scared and worried about the world and why it seems like intruding on their privacy is safe, but please read the responses and all of the hardship, hurt, and fractured relationships that were caused by such behavior.

/3
I'm really meant what I said about trying to be a parent:

* forever
* that's trusted
* that might not agree but is confided in
* that is actually able to keep people safe by having their advice and guidance listen to
* that has influence on what your kids do

/4
We do this by granting our children respect, privacy, and allowing them to explore their world (and make missteps) safely.

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More from @tylerblack32

31 Oct
While the "serotonin hypothesis" of depression is no longer taught, #SSRIs delay the reuptake of serotonin @ neurotransmitters. We also now know they have a host of other effects (σ1, BDNF, CREB, cytokines, on top of a slew of differences on the various subtypes of serotonin)

/1
The key difference, is that today, we know that the brain changes seen in depression are impairing, and we know that SSRIs work. Instead of drawing a straight line between "serotonin regulation" and efficacy, the honest psychiatrist doesn't understand the current mechanism.

/2
We now suspect that there are a host of effects, second, third, & even tertiary effects, and the complex way in which the brain is interconnected plays a role.

But yes, SSRIs DO block the reuptake of serotonin. It's why we have to be careful about withdrawal and tolerance.

/3
Read 5 tweets
29 Oct
Child psychiatrist here. It is a very bad idea to search your teens room, and a very good idea to respect their privacy and develop them into humans who trust their parents instead of reasonably distrust them.

Do not take advice from this account. The proper # of searches is 0.
Are you not convinced, worried parent? Consider two scenarios:

Scenario 1: I am in trouble because I am using drugs and something unsafe is about to happen. Even though I'm worried about their reaction, I can trust my parents so maybe I should call them.
Scenario 2: I am in trouble because I'm using drugs and something bad is about to happen. But I don't talk to my parents because they invade my privacy disrespect me and I know that talking to them will result in punishment. So, no, I will not call my parents.
Read 5 tweets
28 Oct
Really interesting RCT showing 10 days of 100mg 2x per day of fluvoxamine reduced bad COVID outcomes.

No taper start either! Just bam 200mg daily. Makes ya wonder.
thelancet.com/journals/langl…
Participants: less than 7 days of covid like symptoms or a covid+ test

n=1497, fluvoxamine vs placebo

Outcome measures: >6h in an ER or admitted to tertiary care

Results: 32% reduction in the fluvoxamine group
While the ITT sample didn't reach significance (including dropouts) for death, it should be noted that the death rate for per protocol participants was;

Fluvoxamine: 1/548 (0.18%)
Placebo: 12/618 (1.94%)
RR: 0.09 (95% CI 0.01-0.47)

90% reduction in death rate.
Read 4 tweets
26 Oct
The 2020 @samhsagov study on youth suicidality (conducted Q4), was reassuring. Overall 12% of 12-17y kids indicated serious suicidal thinking, with 5% making plans and 2% attempting.

This is quite improved compared to @CDCgov numbers in 2019, pre-pandemic. (18%, 15%, 9%, 14-17y) Image
These improvements seen across the board (age+sex). Though different agencies, both reports are national representative samples. I certainly advise caution comparing the two to any great detail. At a high level, however, it's very reassuring to not see "much higher numbers" here.
I suspect that we will continue to see higher quality data emerge showing globally that children did not show increases in suicide-related measures during 2020 (which includes pandemic, lockdown measures, and everything else that year!)
Read 5 tweets
20 Oct
Therapists: every now and then, you should scan your patient roster, and see whether the makeup of your patient population reflects the population of people in your area. If it doesn't, for whatever reason, you are part of systemic discrimination. Yes, it will require sacrifice.
I've already seen misinterpretation.

"You are part of" does not mean "solely responsible"
"Will require sacrifice" does not mean "must work for free"

I'm sorry that the world works the way it does, but you are either someone who works to correct barriers or someone who doesn't.
Similarly, reducing your carbon footprint barely puts a dent in the climate change crisis yet doing so, while influencing others to do so, and advocating for change at every level is *necessary* to affect climate change.
Read 4 tweets
15 Oct
Thread Title:
"Vaccine Math for GBD Flat-Earthers"
or "Don't Be Like Kyrie"

Being vaccinated reduces your chance of infection from COVID by about 5-fold.

Consider this the "peer review" for all the 💩GBD/contrarian people who deny that vaccination prevents transmission.

/1
Hypothetical! Math!

100 unvaccinated basketball players (like Kyrie Irving) get a *significant* COVID exposure of some COVID-filled room. Some percentage (let's say for arguments sake 20%) get infected themselves.

100 x 0.2 = 20

Now we have 20 infected players.

/2
Each of these 20 players runs an elite camp with 30 unvaccinated kids (lots of indoor time, some chalk talk, etc). That's 20 x 30=600 exposures. Let's assume it follows the dynamic of the CDC report regarding spread to kids indoors. 50%.

That's 300 kids getting COVID.

/3
Read 10 tweets

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