Antipsychotics and Weight Gain: It Doesn’t Have to Happen (Ep. 129)

Weight gain is one of the most common—and distressing—side effects of antipsychotic medications. For many people, it affects self-esteem, physical health, and even the willingness to stay on treatment. In this episode of Schizophrenia: Three Moms in the Trenches, we talk about why these medications cause weight gain, whether it can be treated or prevented, and what families should understand about metabolism and insulin resistance. We also touch on the growing conversation around the ketogenic diet and its possible role in treatment. What’s evidence-based, what’s still emerging, and how can families advocate wisely? 

 Guest :  Robert S Laitman, MD, is an internal medicine physician at Bronx Westchester Medical Group in New York. 

Book: MEANINGFUL RECOVERY from Schizophrenia and Serious Mental Illness with Clozapine: Hope & Help 

BUY THE 5th EDITION - for an extensive update to Dr Laitman's section, An Optimistic Nephrologist. MoreIn depth data about clozapine and the mitigation of side effects for a MEANINGFUL RECOVERY.Published in December 2025.

We also touch on the expanding reach of Doromind, so more can benefit from Dr. Laitman’s treatment protocols.

https://www.doromind.com/

Keto Diet resources:

https://accordmh.com/

Dr. Chris Palmer has written books about it.

Transcript

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SPEAKER_04 0:02

Seems like everybody's losing weight these days. GLP1's metformin, increased exercise, the keto diet. But can these things make a difference for someone on antipsychotics? We explore with our guest, Dr. Robert Leitman, weight gain as a side effect of antipsychotics. Can it be avoided? And how do we treat it? Welcome to our podcast, Schizophrenia. Three moms in the Trenches. From the place where schizophrenia and real life collide. With Miriam Feldman, Mindy Gryling, and Randy Kaye. On this episode of Schizophrenia Three Moms in the Trenches, we uh we want to bring up a topic that many, many of our listeners have asked us to cover, which is basically about weight gain as a side effect of medication. And I think this is true. Yes, many psychiatric medications, including antipsychotics, antidepressants, and mood stabilizers, commonly cause weight gain by affecting appetite and metabolism, which can be a significant reason for patients to stop treatment. So I fact check that. I don't think we need to. We know that it's been an issue with all of our sons and probably with some of your patients. And with us tonight is one of our favorite, favorite guests and one of our most listened to episodes, or a couple of them are the ones you've been on. Dr. Robert Leitman, welcome.

SPEAKER_00 1:33

Thank you. Always good to be here.

SPEAKER_04 1:36

So if you're new to the podcast, because this topic may bring people in, I'm Randy Kay. I'm here with Mindy Grinling and Miriam Feldman, and we are the mothers of sons with schizophrenia. And we have each written an acclaimed book about our experience, and we continued sending the messages with this podcast. So welcome to the podcast. If you're new, welcome back. If you're not. So I haven't prepared any specific questions, but um I know we've had you on before, Rob, and your approach, just if someone hasn't seen or listened to the episode, is to not just prescribe, because you're a nephrologist by trade, so you understand the interactions of medications and the name of the book that they can um get for you talking about clozapine and the combinations is Meaningful Recovery from Schizophrenia and Serious Mental Illness.

SPEAKER_00 2:37

Very importantly, get the fifth edition because the fourth edition is still in print. Don't get that. Get the fifth edition. It will take you through how to avoid weight gain. And it'll also take you through the mechanisms. But we can talk about this. And it is, you know, I was told this very early on when my son first got sick. What do you want, your body or your mind? And I'm sure a lot of you have heard all that, and I think it's a false choice. It's not like this thing is just sitting on top of the body. There, you know, it's you know, it's connected. Your brain is part of your body, and you can have both a good body and a good brain. You're right, so you have to do the work.

SPEAKER_04 3:30

How have you done that? Like, is it uh what here's my first question to you Is it does it do the medications cause weight gain or do they cause an effect that causes the weight gain?

SPEAKER_00 3:41

They cause weight gain. That's what I want to. I want to you always want to start with mechanisms because if you understand the mechanisms, then you can get to the solution. All of the antipsychotics, especially the second generations, the one with the serotonergic actions, they will cause weight gain. So having anti dopaminergic effects, uh activities against serotonin, things that we call anticholinergic, antihistaminic effects. All of these affect appetite in a really meaningful way, especially the antihistamines. They just kill your ability to recognize when you're full and you just continue to eat and eat. Same thing with things where you have anticholinergic drugs. You know, you disrupt those pathways, and again, you eat. Same thing with serotonin. You block 5HT2C, thank you. It doesn't really matter, you don't need to know that. And that disrupts metabolic pathways and disrupts appetite as well. And anytime.

SPEAKER_03 4:51

Let me ask a question here. Why, if we know this, and we've known this for a very long time, why are there so many doctors out there that don't uh warn families about this and patients, and also don't start anything to mitigate this from the get-go like you do?

SPEAKER_00 5:10

Because they've never been taught. There's been this artificial separation, which drives me nuts, between behavioral health and physical health. That's my point. Uh psychiatric care is brain care, it is physical health. Um, they need to be taught this. And that was the prime one of the primary driving forces and a large impetus in us originally publishing our book and approaching a lot of people was us mitigating the side effects and especially the weight. Daniel, my son, who most of you know on this broadcast, has been on clozpine now for 20 years. Prior to going on to clozepine, he went from 130 pounds to close to 170 pounds on the other antipsychotics. Again, this is before my wife and I became involved in his care. Um, you know, he was also about 5'2, 5'3 now. So now on clozapine, which along with the lanzepine, are noted to be the two drugs that are the worst offenders in terms of, you know, and you can think about it because they're the most anticholinergic. They uh, you know, really have strong uh serotonin properties, they're all both antihistaminic. Those are the two drugs, the big offenders in terms of weight gain. Yet my son now weighs a hundred and thirty five pounds and has grown, you know, because when he got sick, he was 15. So he's grown another four inches since then. And it's because we learned to pay attention. There is remarkably, 20 years ago when we started this, there was very little written. There wasn't even talk about mitigating the side effects. The the information was already out there that we knew these drugs did this, and in fact, there was a big push away from a lanzepine and clozepine, particularly, because they said the side effects are so terrible, as opposed to as you would you would think you would think going after and mitigating the side effects.

SPEAKER_04 7:18

So that is helpful to know. I'm still hearing though that there's a that the drugs cause you not being able to recognize that you're full, so that you are eating more. That's correct. Okay, so it isn't just like the drug makes you gain weight, the drug affects your metabolism and your appetite awareness.

SPEAKER_00 7:41

That's correct. And it also causes it also causes disruptions in the way insulin is handled in your body, especially clozepine. It makes insulin a less effective molecule, it decreases GLP1, which as most people also know is the active ingredient in our little uh Ozempic uh Mungeros and Right.

SPEAKER_04 8:05

So let's you know, let's let's get I'd like to ask um about uh metformin, I'd like to ask about the GLPs, and I'd like to ask about keto diets. So let's do one at a time and Mimi, you know, feel free to chime in.

SPEAKER_00 8:18

But I so yep, there's lots of ways of going about this, and you know, you don't wait for the weight gain because this is the physiology you know you're gonna have to treat. The weight gain can be incredibly impressive in an incredibly short time. I've seen and had other people gain 50, 100 pounds in a few months, and there's just no reason for this. So the first thing that we do is within the first month, we start metformin. Now, I only use the extended release metformin because metformin can have some fairly significant uh GI uh side effects, uh gastrointestinal side effects. It can cause nausea and it can cause diarrhea. Actually, the diarrhea, if you're especially using it with clozapine, is rather useful because it balances out the constipation. So actually, it often restores their bowel function close to normal. And the key is being patient, you know, and doing it in a fashion to make sure that they tolerate the medicine. So you start with metformin, you always start with just 500 milligrams a day. A one proviso, you must make sure that they have normal kidney function. Uh, people on that take metformin, metformin is metabolized by the kidney, and severe renal failure is a contraindication for using metformin. Again, most of our kids are young, it's not a big deal. You know, if you can get down to um fairly significant chronic renal failure and still use metformin. But so for our kids, almost everyone has essentially normal kidney function. You start at 500, you make sure that they are tolerating the med, they're not having nausea or vomiting or diarrhea, and then you wait a week or so. See how they're doing, and you try to increase that. And you do that in 500 milligram increments. And you so you'll go 500 milligrams for breakfast, you'll add a 500 milligram dose at night. Most of my kids, just because of the complexity of their regimens, are not on dosing a single time a day. They most of my kids require a twice-a-day dosing, and that's because of the medicines that I use to mitigate a lot of the side effects. And then you again, same thing. You wait another week or two and you go to a thousand milligrams in the morning. Sound familiar, Mindy? Miriam? It sounds familiar.

SPEAKER_03 10:54

So let me then eventually as our listeners know. Uh well, let me finish.

SPEAKER_00 10:59

Then you get to a thousand twice a day. That's that's your goal dose, and you see what you have with that. Now, with metformin, it does cause B12 bowel absorption. So you add B12, very easy, you know, and it's very tasty. Most people, you can go get it a little chewable pill, and it's more than enough. I'm sorry, go on, Mindy.

SPEAKER_03 11:19

Yeah, so what I would like for the listeners, because Mimi and I, as many of our regular listeners know, are fortunate to have our sons have you for their doctor. So we are like so blessed. But for the ones who don't, and before we had you, I read your first book or the last edition anyway, and then Jim went to his primary doctor because his psychiatrist wouldn't prescribe anything to deal with the side effects. She was a psychiatrist. He needed to go to his primary care. So he went there and asked for medformin. And I educated him about, and he really had gained 150 pounds, as you know. And so he really needed medformin and he went to the his primary doctor and she said, that's for diabetes. That's not uh, and luckily Jim is argumentative as Dr. Leitman knows. And so he argued with her and she went and got the manual, and sure enough, it said an off-label use was uh for antipsychotic weight gain. So she finally gave it to him, but he didn't get any of the other things that you prescribe for other side effects. So, what can we say to listeners who have psychiatrists, which I think most people actually probably do, like the one Jim had. She won't prescribe anything for side effects, and then you go to the primary care, and the two aren't communicating, and the poor patient is left there trying to um advocate for themselves.

SPEAKER_00 12:48

Uh times have changed, Mindy. So in uh England, there's something called the Maudsley guidelines, which are the general guidelines that are written by a fellow by the name of David Taylor, who's also a very big clausepine advocate. And he essentially they've changed the guidelines in England. They start medformin right away. If you I believe this to be true, I know it was planned. I haven't actually read this, so don't hold to it. But I'm pretty sure the more recent APA guidelines are to add metformin early on.

SPEAKER_03 13:23

This was like eight years ago, so that must be five.

SPEAKER_00 13:26

That was eight years ago. Yeah, no, no, this is all very recent because you know the drumbeat has gotten a lot louder. Wonderful.

SPEAKER_04 13:34

So eight years of those eight years have gone by. So let me ask you now, because I think it certainly makes sense to prevent the weight gain rather than deal with the weight gain. Absolutely. And now the GLP ones are all over the place. Right. Like all that. So is there a place for those medications now that they're becoming pretty widespread? And and I know the last thing someone on wants is an injection, but now there's the pill form. The injection is once a week, the pill is probably once a day. Is that something that is effective? And do you find that well, see, your patients are like you're their gurus that they'll probably do whatever you tell them to, but do you think I wish that was the case. Okay, so maybe not. That's my impression. But like my son is like, it's enough that I'm doing this. I don't need another medication. Like he doesn't even want to take side effect medication. So uh fortunately, right now his weight is okay. But you know, so I guess the first thing I want to ask you is about the GLP ones and the availability now. And then do you get any pushback from the patients who don't want to take another med?

SPEAKER_00 14:44

Oh, all the time. I mean, what what is the biggest barrier to care? It it's anasognosia, the unawareness of the illness and also the unawareness of what you need for yourself. That is part of this syndrome. And so these kids really have no clue uh about what medicines are are needed, but they do object to taking more and more. And there it's so I still get pushback. Randy, the big advantage I have is I stopped taking new patients years ago. So over the over the years, people have gotten used to me and I've gotten used to them. And I trust you I love my I love my patients, and I, you know, and I and I I think they know that. And so I I try to be kind to them, and they also understand they know my history because I share about Daniel. So I I have certain innate, you know, advantages. Um, and also I have family members that are very, very committed. But there, if you can give, and I still can't convince everyone, I mean, there are still kids out there that fight me tooth and nail, uh, despite all of those advantages. So it's always going to be an imperfect world. But you always start with metformin. And then, you know, even when uh so we looked at, let me just give you some data for the first 120 patients, two years on, this data's a little bit old. Um, we saw only uh on average, the kids that were either underweight, had a body mass index of less than 25, was the only group, and this is before I started using the GLP ones. So you don't need it in everyone if you can get diet and exercise and all the rest. They gained weight, but that was intentional. But all my overweight patients, which is a body mass index of 25 to mildly obese 35, on average lost 11 pounds. My patients that were over 35 BMIs lost on average 34 pounds. Now, since the GLP1s came in, it's been an incredible game changer. The the degree of weight loss is no longer 30 or 40 pounds. We're talking 50, 100 pounds. It really is quite remarkable. One mistake that doctors do is they get rid of the metformin, though, when they add the GLP1. That is an error. The mechanisms are actually complementary, they're not exactly the same. You want to use them both ideally, and when you're using the GLP1s, there is differences between there's three of them. There is semaglutide, dualaglutide, which is uh trulycity, and then there is terzepitide, which is actually not only an SGL or a uh a GLP1, but is uh has another mechanism in excellent insulin polypeptide. Um that one with the dual action of mechanisms a little bit more effective, but they all work. And the same thing, like where we started with metformin and being patient, you have to do the same thing with the GLP1s. You start at the lowest dose.

SPEAKER_04 18:15

That's normally how they're how they're prescribed, I believe. So that's the same GLP1 and Metformin. Did I miss it?

SPEAKER_00 18:22

Absolutely, absolutely use them together. Um, especially when you're dealing with people that have gained 50 or 100 pounds. You're just on the whole not going to get the amount of weight loss you need, uh, especially with these kids that have come to me, like uh Mindy's child, who was 150 pounds overweight. I I would never have gotten Jim down to where he is. Um the my best is uh one person who was 390 pounds, who now is less than 160 pounds.

SPEAKER_04 18:56

I mean, I know Mimi has a question about keto, but um before that I just want to I had this theory when when my son was on clozapine, Muchin no longer is. Um not because I don't want him to be on it, but it's just that he doesn't. So that's that's the maybe someday.

SPEAKER_00 19:15

But right now, I know I want to talk more about the GLP ones also. But go on, okay.

SPEAKER_04 19:20

Yeah, but my so what I noticed about his weight gain is it it was not only that he had a hard time knowing when he was full, but he truly was craving carbs, like a lot of carbohydrates. And um, I'm sure that's not the best. Is that part of the effect of the antihistamic?

SPEAKER_00 19:43

Absolutely. Absolutely. The antihistaminic nature, especially their their car craving carbs, but the GLP1s are starting to get other indications like for binge eating disorder. It really works centrally to decrease your appetite. And what is incredibly cool is and where a lot of the kids have objected, is that it was injectable weekly, right? That's what you've been told. Well, semiglutide actually has been out as a drug called uh rebelsis, and it was out in smaller doses. And uh I forget the company now that makes it, I shouldn't know that, obviously. Uh, but it doesn't matter. They're coming out with larger doses. It won't be as effective as the injectables at the higher doses. But when you add it to metformin, you can see quite significant weight losses. So that's going to be a new availability. I believe it's up to 25 milligrams daily of uh semaglutide that's coming onto the market now. And you add that to metformin, especially in kids that are needle resistant, and there are those kids, they just won't do an injection. Uh, that will make uh you know availability for better weight loss. The other thing that you want to talk about with the GLP1s are not only the weight loss from mechanistically, you know, the their effects on insulin resistance, the GLP, uh it actually it decreases gastric emptying, so they do get filled up faster, they have that effect. Um, but it also works centrally and it increases insulin in the brain, and that works to decrease appetite as well. So it these are incredibly, incredibly important medicines. And if you're going to be using the most effective antipsychotics, as particularly the most effective antipsychotic, you're really you're doing a disservice if your your child you you allow that your child to gain weight. There are other things you could do, there are other tricks of the trade as well, but more importantly, Kids get better, you know, and again, everyone knows that I'm a clozepine maven, and that's basically all I use. Well, clozepine, even though it's known as the worst drug, the worst offender, as I said, we've had dramatic weight loss in our population. And part of the reason is they get well enough to fully participate in the program. I'm proud to say I have my first three-hour marathoner. Um, he did three hours and 49 seconds down in in Philadelphia with me uh just last uh actually two months ago in November. Uh so exercise is critically important. And if you can engage your child in regular exercise, we talk about the magic bullet. That's the truly only magic bullet we have, that and diet. And I know you want to talk about diet. So anything that improves your metabolic health also improves the metabolic health of your neurons. So it's going to help, and also your glia. It improves the metabolic health of all the cells because neurons are not all that matter in your brain. That's all you hear us talk about. But glia and microglia and uh the other the astrocytes and so on, these are there's more of these cellular types in your brain than there are actually neurons. And they all interact with each other. So when you're improving the metabolic health overall of your entire body, you're doing the same thing in your brain. And that's the point where uh Dr. Palmer and uh Matt uh uh Bernstein that I mentioned earlier, working with the cord and uh uh and uh working with the keto. The diets. So the keto diet is just a mechanism to improve metabolic health. He talks about improving how the mitochondria, which are the engines of your cells, work better. And if your engines, your cells are working better, they're making more proteins. So they're gonna be making more dopamine, they're gonna be uh working to work on the structure of the cell, connections are better. You're kind of rebuilding your brain with these drugs. And that's what I explain to people.

SPEAKER_04 24:23

Right. But is that, and here's my question. But these drugs and within the case. But but it doesn't matter which one of us asks it. I have heard, listen, where wherever we have our podcasts where where people can make comments, there's always somebody who pops in and goes, if everybody would just go on a keto diet, we wouldn't even need antipsychotics. So that's my question. Okay.

SPEAKER_00 24:46

That I that's we have a strong disagreement. Well, actually, that's not a strong disagreement. I've talked to uh these both both fellows, and they basically have said, Look, we're only here to improve the metabolic health of the brain. They think uh early on in people, remember, if you take a clinical high-risk individual, we don't know what you can do to influence that course. We really don't know. So let's say we can identify clinical high-risk individuals before they develop psychotic illnesses. We know obviously you want to avoid POT, you want to avoid stimulants because those increase your risk of going on to illness. The question is, what happens if you put this kid on a diet and you start a keto diet, you improve their metabolic health. So normally a third will go on to full-fledged psychotic disorders, another third will have certain features, may not be perfectly normal, but be somewhat functional, and a third will go on to have essentially a normal life. So it's not a magic bullet, it's another in that, but in that setting it may be, but we're studying that. We don't know yet. And there are studies going on in clinical high-risk individuals whether a keto diet can be something that can influence. And I think it will. I think anything that changes, you know, the the trajectory, and also part of doing a keto diet, you have to understand, is also there's what's called a treatment effect. They're getting contact, they're getting uh, you know, not only the diet, but they're learning how to be disciplined. They're they're getting contact with other physicians, with dietitians, with cheerleaders. That's why we talk about a biopsychosocial effect. So these studies you're gonna have to be very careful about, and what they're going to have to do to really make them meaningful is to provide the the background of having these kids go and and meet with the doctors, the nutritionists, and not have a keto diet.

SPEAKER_04 27:00

And you know, okay, so let me think about for our listeners that are always stating we wouldn't need any antipsychotics if only everybody would go keto. What I'm hearing you say, because I I just want to sum it up in my head, is it can be an effective tool when you help the metabolism, it helps the metabolism in the brain as well. That's correct. And but these studies are very controlled because they're in controlled environments with lots of biosocial care as well. Biosychosocial care, right? Biopsychosocial care. So it's not necessarily a this will eliminate the needs for antipsychotics because there's there's a lot to study. The other issue is anasygnosia. My son would never, he's a V he's a vegetarian, he would never go on a keto diet. So that you know, you you run across the same issues with asking them to change their diet that drastically, but it probably does help some people. Am I hearing that right? Or did I miss it?

SPEAKER_00 28:01

Yes. So what I I wrote this is a little paragraph in the book. There's been much discussion of ketogenic and gluten-free diets in recent years, and there is reasonable evidence of their benefits for weight loss and even for improvements in psychiatric status. However, claims that they can treat psychosis are exaggerated. You can't control psychosis with a diet alone. I'm sorry. There is no good evidence for that. Not, it doesn't exist. And people come off completely. That's a mistake. Now, can you come down on your existing antipsychotic? Can it improve the environment? Yes, I think there's starting to be evidence for that. That's not conclusive, but there's starting to be suggestive evidence. So let me ask you this then.

SPEAKER_03 28:56

Would you ever recommend that for Daniel or any of your patients that they go down on clozapine and go to the keto diet uh partly?

SPEAKER_00 29:04

No, I wouldn't recommend it quite that way. Um, I think I kind of suggest the keto diet, except not in the extreme case, in that I tell people what's the my diet tenants are never drink your calories because that's the number one, you know, empty calories, simple carbs, sodas, uh, these energy drinks, God forbid, um, you know, juice. That's just they're totally empty calories. And what I say is really stay away from processed food, the simple carbohydrates and all the rest. So a true keto diet does tend to emphasize a higher fat diet and a higher protein. I don't push that to the same extreme as a true keto diet. Uh, what I do is I make sure that they have a lot of soluble fiber and vegetables. So for all my patients on clozapine, the big worry and why I don't push it, because my kids are on closapine, and clozapine affects bowel function. It slows down bowels. So if you don't have a lot of soluble fiber, that's vegetables and fruit. And fruit I I can live without, and that makes it much more ketogenic, staying away from the fruit. If they just stayed with vegetables, uh, you know, uh a high saturated, you know, the oligosaccharides, uh, the the fatty acids that they they like to endorse, um, and uh a fairly high protein diet, it's not a bad deal.

SPEAKER_03 30:47

So that's as long as they have enough vegetables.

SPEAKER_00 30:51

It it's similar to the Mediterranean diet, in except there's some pasta still in the Mediterranean diet. Um, it's the keto diet is different. I mean, because the true keto diet, honestly, you want to get to the point where your brain is using ketones um for their energy. I mean, that's and my diet, I I provide enough of the really complex carbohydrates that they don't get true ketosis. So that's where there is a difference. You know, is do you need true ketosis? And this is an unanswered question yet. Or can you get to good metabolic health using a Mediterranean diet and exercise? And which is better? Honestly, we don't know. We don't know. And I think, you know, having read Palmer's uh book and all, I you know, it's it's very suggestive, but it's not it's not hard and fast. I mean, clearly ketones do different things to your brain. For instance, people that have had uh certain forms of epilepsy, just being on a ketotic diet decreases the risk of having seizures. So that's particular to ketones. Metabolizing ketones may be a good thing for your brain. But as you also said, Mimi, good luck, you know, uh getting these kids outside of a very structured format to do this. So the two kids that I've seen success with have gone to this place called Accord in Boston, where they're given meals, where they're given exercise, where they're really good, and they've both shown reductions in both symptoms, and they were able to reduce my doses of antipsychotics. But that's an N of two. It's interesting, it's provocative. They did not come off, they did not come close to coming off. They both still have very significant closine levels, but it is, at least at this stage of the game, seems to be useful.

SPEAKER_04 33:06

All right. So I think we've we've just want to ask Mindy and Mimi before we leave this subject. Is there anything we haven't covered? I'm pretty satisfied, but is there anything either one of you want to bring up as a question?

SPEAKER_03 33:18

I have one quick question. So does metformin or the other the shots provide any benefits besides weight loss?

SPEAKER_00 33:30

Oh, yeah. Well, again, so again, they're just like we've been talking about, Mindy, anything that improves metabolic health is going to improve uh neurologic health. Uh so Roger McIntyre up at Toronto is doing a lot of this work looking at neuropathology. And these drugs are really uh beneficial neurologic drugs. Anything, anything that improves general health of all your cells in your body improves uh, you know, so it's not only for weight, it is for the actual psychiatric disease that you have. Is it going to be like a light switch going off? No, of course not. Nothing usually is, but it is one of the benefits. Um, and again, if people do lose weight and then they add exercise to that, now now you're really talking. So again, we we do have tools. Make sure your treating physicians use these tools. Make sure they're not going to be able to do that.

SPEAKER_03 34:31

The reason I'm asking that is because Jim is now at his ideal weight, and so he is at not your recommendation necessarily, but the place where he is, they've taken him off, he's off of medforman and uh Moonjaro, and so he's he's at his ideal weight, but he's gonna lose the benefit of the other benefits.

SPEAKER_00 34:52

That's correct, but I'm gonna re-add it. Thank you. You know, don't worry, you know, there's always negotiated settlements. And with Jim, you know, as I said, it's not, you know, you you you really I was so for all others involved, Jim was put into in you know, a semi-independent but supported housing. It was a huge transition, and I made the decision to eliminate anything that I could that could rock his boat in the short term. So, in that setting, that was a short-term gain so that I can get long-term gain. I just need him to accept where he's at. I wanted the housing to accept what we're doing. Okay, and and then I will go back to it because I'm always playing the long game.

SPEAKER_03 35:44

I know you are, so that's why I asked. So thank you.

SPEAKER_00 35:48

Yes, and I and I do believe in these in these medicines. I mean, metformin is my probably third favorite drug, and the GLP ones are my fourth. You guys know my number one and number two, of course. Clozapine and lithium.

SPEAKER_04 36:02

Clozapine and lithium. Okay, you haven't really. I thought you were gonna say clozepine and clozepine. Well, closapine's one in one, but Rob, we have we have just a few minutes left, and I I'm I'm knowing now, you know, because when I know you're not taking any new patients, and I'm betting there's a listener out there going, Why can't I get him to be my doctor? So, what else do you want to share with us in the next five minutes that we have?

SPEAKER_00 36:29

This is this is getting very exciting. So the first time I came on this broadcast was almost five years ago, four and a half or so, five years ago. And the one thing that was really bothering me even back then was I'd run out of capacity. Uh, there's a little thing in this uh medical thing that sends, you know, what's what's deadly to physician. And the deadliest thing to physician is burnout. And that's one thing I just never wanted to have. And and I and I felt myself starting to get overwhelmed. So out of sheer protection, I stopped taking new patients. But it really bothered me because I would hear story after story after story. Uh, so Dora Mind, who's already been on this broadcast with me a little earlier, has been working and we just finished our first two years of existence, and we were continuing to expand. And we just in fact hired someone in California, which essentially doubled the number of patients that we can now treat, essentially, because now we go from just being in Massachusetts, New Jersey, Connecticut, and New York, and Florida, which is also relatively new, and in California. Now all of a sudden we have a population of about a hundred million individuals that we can provide care for or will be able to provide care for. And that's what I'm letting people know. We can provide care for your kids. Um, we have gone from the website. What is the website for that?com. Believe me, we're gonna hit capacity there too. They're already starting to be because we can only add them so fast because the problem is I have to supervise still everyone that gets added on. Fortunately, my nurse practitioners, two of which are also uh doctors of nursing, um, are really getting exemplarily good, and they need less and less supervision. I still meet with them every week, but now, you know, it's basically more what's the problem book we talk about. I don't know the details everyone, so I won't I won't sell it that way because I really don't anymore. But it's showing, and my biggest fear was when my wife and I were done, was that our approach was going to die with us.

SPEAKER_02 39:00

Right.

SPEAKER_00 39:01

But I'm I'm starting to be really optimistic because we're also starting to get insurance companies on board that not only will there be availability, but our the other huge obstacle is affordability. It's not a done deal yet, but we're we're getting a lot of bites. We're actively involved with three insurance companies, which I can't name because it's not none of them are done. We were hoping to actually get it done last month with one, but we wait and we wait and we wait.

SPEAKER_04 39:34

That will help a lot of families. And this information will be in the show notes.

SPEAKER_00 39:42

Right? There really is. And it's again, depending on where your kid is, where you live. So, in other words, can you get court-mandated treatment for something? Some places you still can't. Connecticut is the one place in Massachusetts right now, for instance. Um sometimes they'll only do, as Randy knows, what they'll do. And uh, you know, so you can't use the most effective treatments. All the medicines work to a certain degree, to a certain degree. I believe there is the correct way of doing it. If you can get it done, you use the most effective treatments, that's all. And you pay attention to the family, and you use the family and you engage them, and that's what Doralmine does. You know, it involves everyone, it you know, it's embracing. So, what are my two criteria for taking care of people? What do you have to be? You have to be competent. And competency is a major problem in psychiatric care, but you also have to be kind. Those are my two things.

SPEAKER_04 41:02

And everybody in Doromind meets those two seconds.

SPEAKER_00 41:05

And Doromine meets those two criteria. So that's that's all I really wanted to talk about.

SPEAKER_04 41:10

That is wonderful. And we're we're we're at our limits. So I'm you know, I thank you. In in this um, in this episode, we've talked about weight gain, we've talked about why it happens, we've talked about ways that we can prevent it and ways it can be treated, and how it can benefit the brain when you're benefiting the body, because it's all one system, and the increased availability of Doromines. So, Dr. Robert Lateman, thank you, even with your beard. I like it. Um, but your wife probably doesn't. Uh, you know, thank you so much.

SPEAKER_00 41:41

It's not a done deal yet.

SPEAKER_04 41:42

All right, thank you so much for joining us. If you want information about the other episodes we mentioned, that will be in the show notes. Just check it out, and thank you for joining us. Thank you so much for tuning into this episode of Schizophrenia Three Moms in the Trenches. You can help out the podcast and help others by sharing the podcast and by subscribing wherever you get your podcasts andor on YouTube. And remember you can reach us at mindygryling.com, randy k dot com, or miriam hyphenfeldman.com.