Dr. Rege

Ever wondered why AuADHD (Autism + ADHD) brains respond so differently to stimulants? 🚨

Some patients say:

“I felt tired.”
“I was anxious.”
“It actually made me worse.”

Why does this happen and what does it mean for treatment?

I’m releasing a new video in just a few hours where I take you through the neurobiology, the clinical patterns I see, and the strategies that can make a difference. 🚀

Subscribe and hit the notification bell so you don’t miss it.

See you soon
Dr Rege

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2 weeks ago | [YT] | 52

Dr. Rege

The Default Mode Network (DMN) is often implicated in “overthinking.” 🚨
Which of the following best describes its core function?

1 month ago | [YT] | 29

Dr. Rege

Mitochondria are critical in psychiatric disorders primarily because they:

Check out the new video release to learn more 👉4 Ways to Supercharge Your Mitochondria for Better Mental Health
https://youtu.be/z_3xypCLIF8

1 month ago | [YT] | 57

Dr. Rege

𝐅𝐨𝐫𝐦𝐮𝐥𝐚𝐭𝐢𝐨𝐧, 𝐍𝐞𝐭𝐰𝐨𝐫𝐤𝐬, 𝐚𝐧𝐝 𝐭𝐡𝐞 𝐅𝐮𝐭𝐮𝐫𝐞 𝐨𝐟 𝐏𝐬𝐲𝐜𝐡𝐢𝐚𝐭𝐫𝐲 🚨
𝘍𝘳𝘰𝘮 𝘐𝘯𝘵𝘦𝘳𝘢𝘤𝘵𝘰𝘮𝘦 𝘢𝘯𝘥 𝘋𝘪𝘴𝘦𝘢𝘴𝘦𝘰𝘮𝘦 𝘵𝘰 𝘏𝘦𝘢𝘭𝘵𝘩𝘺𝘰𝘮𝘦

In psychiatry, the aim isn’t to oversimplify but to learn how to navigate complexity.

Formulation is the map.

1️⃣ Loscalzo and colleagues (Am J Pathol, 2019) applied network mathematics to illness.

The interactome (all factors) and the diseaseome (changes leading to illness) form stable networks.

Therapies may shift the system into a healthyome, but without multiple interventions to lock it in place, the network drifts back.

2️⃣ The flaw in monocausal thinking.

Take TRD
Instead of asking, “Is this BPAD or Unipolar depression?” or “Is this inflammatory depression?”

The better Q is: 𝐖𝐡𝐚𝐭 𝐧𝐞𝐭𝐰𝐨𝐫𝐤 𝐨𝐟 𝐟𝐚𝐜𝐭𝐨𝐫𝐬 𝐢𝐬 𝐦𝐚𝐢𝐧𝐭𝐚𝐢𝐧𝐢𝐧𝐠 𝐭𝐡𝐞 𝐝𝐢𝐬𝐞𝐚𝐬𝐞𝐝 𝐬𝐭𝐚𝐭𝐞?

3️⃣ Inflammation is one such variable.

It operates across levels:

-Molecular → mitochondrial dysfunction, oxidative stress
-Neurotransmitters → DA and 5HT signalling
-Phenomenology → hyperarousal, slowed cognition
-Symptoms → fatigue, anhedonia
-Metabolic → insulin resistance, weight gain

One factor, multiple domains.

4️⃣ This is why formulation is indispensable.

It integrates:
-Biological
-Psychological
-Social
-Developmental
-Cultural...

Not to force one causal story, but to map how interacting systems shape presentation.

5️⃣ How does this play out in practice?

In the debate of ADHD vs BPAD II, the hormonal hypothesis may link the two, e.g

“𝘛𝘩𝘦 𝘱𝘳𝘦𝘴𝘦𝘯𝘤𝘦 𝘰𝘧 𝘗𝘊𝘖𝘚 𝘪𝘯𝘵𝘳𝘰𝘥𝘶𝘤𝘦𝘴 𝘣𝘰𝘵𝘩 𝘢 𝘩𝘰𝘳𝘮𝘰𝘯𝘢𝘭 𝘢𝘯𝘥 𝘪𝘯𝘧𝘭𝘢𝘮𝘮𝘢𝘵𝘰𝘳𝘺 𝘩𝘺𝘱𝘰𝘵𝘩𝘦𝘴𝘪𝘴. 𝘊𝘺𝘵𝘰𝘬𝘪𝘯𝘦-𝘮𝘦𝘥𝘪𝘢𝘵𝘦𝘥 𝘱𝘳𝘰𝘤𝘦𝘴𝘴𝘦𝘴 𝘩𝘦𝘪𝘨𝘩𝘵𝘦𝘯 𝘢𝘮𝘺𝘨𝘥𝘢𝘭𝘢 𝘳𝘦𝘢𝘤𝘵𝘪𝘷𝘪𝘵𝘺 𝘢𝘯𝘥 𝘥𝘪𝘴𝘳𝘶𝘱𝘵 𝘱𝘳𝘦𝘧𝘳𝘰𝘯𝘵𝘢𝘭 𝘧𝘶𝘯𝘤𝘵𝘪𝘰𝘯𝘪𝘯𝘨, 𝘤𝘰𝘯𝘵𝘳𝘪𝘣𝘶𝘵𝘪𝘯𝘨 𝘵𝘰 𝘦𝘮𝘰𝘵𝘪𝘰𝘯𝘢𝘭 𝘥𝘺𝘴𝘳𝘦𝘨𝘶𝘭𝘢𝘵𝘪𝘰𝘯 𝘢𝘯𝘥 𝘤𝘰𝘨𝘯𝘪𝘵𝘪𝘷𝘦 𝘴𝘺𝘮𝘱𝘵𝘰𝘮𝘴 𝘢𝘭𝘪𝘨𝘯𝘦𝘥 𝘸𝘪𝘵𝘩 an 𝘈𝘋𝘏𝘋 phenotype. 𝘏𝘰𝘳𝘮𝘰𝘯𝘢𝘭 𝘥𝘺𝘴𝘳𝘦𝘨𝘶𝘭𝘢𝘵𝘪𝘰𝘯, 𝘱𝘢𝘳𝘵𝘪𝘤𝘶𝘭𝘢𝘳𝘭𝘺 Es–Pro 𝘪𝘮𝘣𝘢𝘭𝘢𝘯𝘤𝘦, 𝘧𝘶𝘳𝘵𝘩𝘦𝘳 𝘦𝘹𝘢𝘤𝘦𝘳𝘣𝘢𝘵𝘦𝘴 𝘢𝘧𝘧𝘦𝘤𝘵𝘪𝘷𝘦 𝘪𝘯𝘴𝘵𝘢𝘣𝘪𝘭𝘪𝘵𝘺.”

This is just one illustration.

6️⃣ In psychiatry, we constantly see processes operating across multiple levels- iron deficiency, hormonal signals, pain syndromes, etc

Each construct = clues + opportunities.

Pluralism + formulation + marginal gains = sustainable outcomes.

7️⃣ Every intervention matters.

- 2 low-dose agents > than one high dose.

- Medication gains are amplified by therapy, behavioural strategies, and social supports.

We'll cover this in the Academy webinar: Aggregation of Marginal Gains with Professor Michael Berk – recorded & on-demand on 26th AUG- www.academy.psychscene.com/events/marginal-gains-i…

For deeper skills, see Advanced Psychiatric Formulation for Clinical Practice. www.academy.psychscene.com/courses/advanced-psychi…

In the AI era, it’s tacit knowledge & narrative intelligence that will set us apart.

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1 month ago | [YT] | 28

Dr. Rege

Antidepressants & Discontinuation: Why Stopping Is a New Adaptation, Not a Rewind Button 🚨
10 KEY points to consider

Antidepressants are prescribed to help create stability.

But stopping isn’t just a 'reset ’- it’s a new physiological change with multiple possible trajectories.

1️⃣The process:

A. Person has distress (symptoms).

B. Medication is prescribed.

C. Medication helps reduce distress, allowing for some stability.

D. Person decides to reduce.

*Note that at this stage, it is the shared decision-making that is important - discussing risks, benefits, short and long-term, and alternatives with their risks and benefits.

2️⃣Something often overlooked:

The fact that a person can now consider stopping means the medication (as one component of Rx with varying weighting) helped them reach a point of stability.

Without medication, they remained at point A.

For the patient, before initiation, the decision isn’t binary.

It’s:

-Current distress vs. relief with meds

-Alternative strategies vs. no intervention

-Non-medication strategies vs. starting meds

-Waiting it out vs. taking action
etc

Each path has trade-offs.

Decisions should be informed, not ideological.


3️⃣ Early discontinuation vs. long-term use:

If side effects appear early, many stop within 2-6 weeks before significant neuroadaptation occurs.

But if a patient has been on treatment long enough for stability, stopping is not a simple reversal-it’s a new adaptation process.

4️⃣When reduction starts, the 'nervous system' must readjust again.

What happens next depends on multiple factors:

The possible pathways:

1. Withdrawal symptoms that subside, allowing successful discontinuation.

2. Withdrawal symptoms requiring prolonged tapering-the 'nervous system' needs more time to recalibrate.

3. Withdrawal symptoms worsening the condition, potentially triggering a relapse that might not have occurred otherwise.

4. Withdrawal and relapse blending together, making it challenging to separate true recurrence from withdrawal distress.

5️⃣ But this process isn’t just about the patient and medication. ❌

While the person undergoes a process of neuroadaptation (new) from stopping the medication, they are also navigating external allostatic loads (stressors) - both positive and negative.

Factors involved:
- Doctor-patient relationship (support, monitoring, guidance)

-Job stress, relationships, family, children etc

-Psychosocial variables affecting resilience

-Past illness and how distress was previously expressed (anxiety, mood symptoms, somatic complaints, etc.)

6️⃣So, now you don’t just have:

Patient + neuroadaptation from discontinuation ❌

You have patient + ongoing life stressors + physiological shifts from stopping the medication + residual / treated symptoms. 🚨

Any of these variables can tip the balance, influencing whether discontinuation is smooth or destabilising.

Moreover, short-term # long-term

7️⃣This is why the decision to discontinue and tapering must be individualised.

There are no universal rules. This is a new situation

Stopping is not just “removing a drug” with tapering protocols.

BUT

Navigating a new homeostatic shift while balancing external stressors.

This requires a risk-benefit analysis.

8️⃣ BUT the patient isn't a Hyperbolic Curve. 🚨

Good Deprescribing requires a good knowledge of Prescribing.

Because tapering isn’t just discontinuing. ❌

It requires understanding the original illness phenomenology, formulation, pharmacology, psychosocial stressors, and skill to differentiate withdrawal from relapse.

Deprescribing without prescribing knowledge is an issue- if distress occurs, the antidepressant takes all the blame.

9️⃣The key question isn’t “Are antidepressants good or bad?” but rather:

Did the medication contribute to remission or functional recovery?

If so, there was a benefit.

Now, the decision to reduce is a separate process that requires its own plan.


1️⃣0️⃣Discontinuation is another phase of treatment. ✅

- The error is assuming withdrawal distress = proof the medication was unnecessary.

-The goal is function and stability, not rigid timelines or ideological debates - On or off medication!

I've covered these concepts in more detail in the video on the Neuroscience of Withdrawal.
👉 https://youtu.be/mDAvvcm4hJw

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1 month ago | [YT] | 74

Dr. Rege

On Edge. Wired. Burnt Out.🔥

I’ve released several videos on fatigue and being “revved up.”

Humans express it in different ways: 🚨
“I can’t sleep.”
“My mind is racing.”
“I’m on edge.”

What we need to recognise is that fatigue and being wired are two sides of the same thread — and that thread runs through the fronto–striato–limbic circuits.

These circuits control key functions I map with PACES:

1. Perception

2. Activity

3. Cognition

4. Emotion

5. Sleep

The brain has compensatory mechanisms — when activation overshoots, it shuts down; when it undershoots, it tries to ramp up. The distress comes from losing control of that regulation.

In this video, I follow a framework:
1️⃣ Identify which functions are affected
2️⃣ Reduce arousal first — because you can’t rev up an already over-revved engine without burning it out
3️⃣ Then, activate when needed — with the circuits calmer, activation works better

More in the video 🎥

Regards
Dr Rege

1 month ago | [YT] | 25

Dr. Rege

Psychopharmacology is misunderstood 🚨

The goal of psychopharmacology is to optimise stability across five functional domains PACES™ to facilitate the process of neuroadaptation.

Pharmacotherapy is one component - integrated with psychological, behavioural, and environmental interventions to drive recovery.

P -Perception
A -Activity
C-Cognition
E-Emotional Hedonics
S-Sleep

1 month ago | [YT] | 58

Dr. Rege

An addiction that flies under the radar. 🚨

It's not alcohol.
It's not drugs.
It’s not even sugar.

It’s in your pocket.
On every phone.
Available 24/7. Free. Private. Endless.

Porn addiction.
A behavioural addiction that hijacks dopamine, reshapes desire, and—unlike other addictions—is rarely talked about until it causes serious dysfunction.

In this week’s video, I explore:

1. How porn rewires the brain like a drug

2. The link to early erectile dysfunction

3. The rise of hypersexual disorder and POPU

4. What science says about treatment and recovery

This isn’t a moral issue. It’s neuroscience.

And it’s time we stop ignoring it.

#PornAddiction #MentalHealthAwareness #Neuroscience #DrSanilRege #BehaviouralAddiction #Dopamine #PsychiatrySimplified

2 months ago | [YT] | 27

Dr. Rege

🧠 NEW VIDEO JUST DROPPED!
Mad or Bad? When Psychiatry Meets the Law

What really happens when criminal law and psychiatry collide?

In this video, I explore 5 real cases where the line between illness and intent isn’t so clear—and where even psychiatrists couldn’t agree.

You’ll meet:
👩‍👦 A mother guided by delusions...
🩸 A man who believed drinking blood kept him alive...
😴 A sleepwalker who woke up in a nightmare...
🏋️‍♂️ A wrestler whose brain changed from repeated trauma...
🍽️ And one case? No illness. Just horrifying desire.

These cases will challenge the way you think about blame, responsibility, and what it means when the brain goes off-script.

🔗 Watch now and let me know in the comments: Which case unsettled you the most?

*(‘Mad’ is used here to reflect a common public debate—but it’s not a term we support in clinical settings.)

#PsychiatrySimplified #MadOrBad #ForensicPsychiatry #TrueCrime #MentalHealth #Neuroscience #DrRege #PsychScene

2 months ago | [YT] | 21

Dr. Rege

Meth and Sex Addiction: The 6-Step Recovery Roadmap 🔄🧠

After the last video on meth and sex addiction, many of you asked:
👉 Why is this combination so hard to treat?
👉 What actually helps?
👉 How do we rebuild healthy sexuality without triggering relapse?

In this new video, I answer those questions and walk you through:
🔬 The neuroscience behind meth, sex, and relapse
🧠 A dual-track model for dopamine reset + sexual reintegration
💊 Medications that support (not shortcut) recovery
🧍‍♂️ How to rebuild identity and intimacy, especially for MSM clients
📈 A realistic, step-by-step plan grounded in clinical practice

This video is designed for clinicians, those in recovery, and anyone supporting someone caught in the cycle.


#MethAddiction #SexAddiction #Recovery #Neurobiology #PsychiatrySimplified #AddictionTreatment #DrSanilRege

2 months ago | [YT] | 31