You are listening to the Global Network of Podcasters dedicated to the pharmacy profession. Welcome to the Pharmacy Podcast Network. welcome back to the pharmacist podcast network the precision medicine pharmacist in part one of our series precision psychiatry and practice a pharmacist physician collaboration we explored how a collaborative approach can begin to reshape psychiatric care, building trust, aligning perspectives, and creating space for more personalized treatment. Today, we move deeper into what looks like real-world integrative medicine incorporated into psychiatry. I'm excited to welcome back Saba Arshad, joined by Dr. Khan, as we explore their partnership and how it brings together different clinical perspectives to care for the whole patient, not just the symptoms, but a broader context of mental health, lifestyle, and individualized needs. In this episode, Precision in Practice, Real Stories, Real Results, and Integrative Psychiatry will focus on the human side of collaboration. How do two clinicians with different training and strengths come together to approach complex cases? What does shared decision-making really look like in practice? And how does integrative model shape a better patient outcome with their patients. We'll walk through real patient cases, explore the dynamics of their collaboration, and uncover how this partnership continues to evolve to meet patients where they are. If part one introduced the foundation, today's episode brings that collaboration to life. Let's dive in together. All right, welcome back to our podcast series for episode two. I would love for both my guests today to just kind of give a brief introduction to themselves. That way you can get to know them a little bit more deeply. I'm going to start today with Dr. Khan. If you wouldn't mind introducing yourself and just give us some background about your practice, and then we'll go back into reintroducing Dr. Arshad as well. Hey, I'm Dr. Khan. I'm an adult and child psychiatrist. I've been in practice about 15 years, 10 years in private practice. And I also do a lot of integrative holistic approaches to my practice and how I treat patients. And even more lately, I've been doing a lot more of precision medicine partnerships to bring in more of an individualized treatment approaches to my treatment care for my patients. Oh, love that. Thank you so much for sharing that. And then that whole integration of precision medicine comes from Saba. So Saba, please give us a reintroduction for those of you who haven't listened in on our first part of the series for reintroduction now. Sure. Hello, everyone. My name is Saba Arshad. Thank you for having us again, Melissa, for this part two. I am a pharmacist and founder of Mediana Health. I have been practicing for over a decade, but I've been practicing Texas for about six years. And my focus has always been not just pharmacogenomics, but looking at my patient from a whole person perspective. And I'm so excited to discuss how we collaborated with Dr. Khan. And I hope you find it helpful. I'm certain that our audience will definitely find this helpful because it really has been more observed in the psychiatric space to really dive into more approaches to treatment and really allowing for it to be unique to the patient and meet them where their needs need to be met, right? So I would like for you guys just to kind of give us an idea of what integrative psychiatry is, what holistic psychiatry looks like as far as a perspective from you both. I'm going to go first and I'll tell you a little more of where I believe it's more holistic, right? For a long time, medicine has had a lot of data, especially internal medicine, surgery. Psychiatry has lacked behind in having that kind of data-driven approach to treatment plans. Lately, we are kind of evolving in some ways in psychiatry to kind of look at things that we can support our patients and be more individualized, more resourceful in terms of, for me, I kind of use this common platform of saying treatment could be a pie. 30% medication, 30% therapy, 30% environment, and 10% have my patient do the work. And when you kind of make it that individualized, then you look at what are the other holistic approaches that they can add in their life in terms of their environment, sleep, appetite. We all know lifestyle changes are a big part of how you approach health. So that, to me, itself, sort of being individualized, being more holistic and seeing a whole body perspective than just seeing. Here is your symptom and here is the medication. So that's what I seem to call more of that holistic or integrative approach. Love that. And I have an interesting statistic around it. I found one saying that approximately 30% to 50% of patients with mental health conditions use some form of complementary or integrative therapy alongside their conventional care. So in general, it's definitely becoming way more common to utilize. And patients are really just looking for better when it comes to treatment for mental health. They're not always wanting to go on the medications first, right? There's things that you need to do nutritionally, sleep management you were talking about. And you work with a lot of, you said adolescents because you're in child psychology. So I know a lot of the listening audience would love some better perspective with their own kids, especially when we're thinking about ADHD management, autism. There's all sorts of things that can be addressed prior to even introducing the thought of medications, right? That's right. I mean, if you mention ADHD, the way we approach ADHD is we sort of start determining who needs to be on meds and who doesn't need to be on meds based on what the dysfunctionality looks like. And if we can have our kids, younger kids population, do a lot more occupational therapy, that's a way of building a sensory system and be part of that to build your brain systems, then maybe we can kind of approach it in a different way, just not with medication. We offer parent and child workshops. So the parent gets to learn a little bit more about ADHD and how to kind of do that parenting with an ADHD kid. And then the ADHD kid gets to understand ADHD a little more and see how they can build their executive skills. So that's part of the integrative approach we have for ADHD kids. Oh, you're speaking to my soul right there. I have a little guy, my son, he's ADHD, and I look for all ways before introducing any kind of medication with him. I'm doing all the things. So whether it be supplemental wise, fleet management, occupational therapies, those types of things. He has support at school and he's doing very well. So I've actually been very pleased with not having to even introduce medication with him just yet. but I know that there are times where it comes to that and I'm wondering kind of what your approach is when you think about determining the medications at that point and how you incorporate Saba into that whole relationship too. So you know the like I said it's the level of dysfunctionality and what defines the level of dysfunctionality is how far you're in trouble at school and at home. If it gets, for me, as a child developmental expert, I say self-esteem is elementary schoolwork. That's where all your self-esteem gets developed. Who you are, who loves me, who does not love me, how much trouble I am, who's watching me, and all of that stuff. So for an ADHD kid who's constantly not sitting in a chair, being told to do the right thing, reminded multiple times, failing at directions is already affecting their self-esteem. and then medication comes in if that dysfunctionality and that effect is lasting enough that it's affecting self-esteem affecting how he performs at school he or she performs at school and where there's what they're doing with that depends on why we kind of decide medication be an answer and when we kind of have approached all the other alternative therapies that i call like doing the parenting part teaching the kids some tools and skills getting to do occupational therapy finding out more of movement in his life by doing martial arts, ways to kind of spend that energy out, what would that look like? And then we sort of end up deciding medication, and if medication becomes a part, then we start getting, most often if it's more of a complicated kid who has other medical comorbidities, that's when we sort of start looking into precision medicine. But more often we approach it with a very simplified, a small dose, short-acting medications. And even if it's not a stimulant, it can be a non-stimulant based on the age, weight, and height and what that looks like. We make a decision. But if it did involve sub-eye, it would be really kind of doing a pharmacogenomics test and figuring out what. And that for a long time was not on the panel. And now it's not on the panel. So I don't know if you've got some experience with that. So you proactively test the, are you implementing the PGX testing right off the bat so that way it's already done so that way you do need to integrate that or do you more kind of wait until it's determined that we're ready to move forward with that? So the cost effectiveness of PGX testing is always what determines if people are ready to get that done or not Although insurance covers in a lot of cases sometimes it does not That kind of makes a huge part of do we really put it out there first? We do offer this to all our patients and say, hey, this is a good approach to start with the limited evidence it has about the final end results. This might help us not have failed trials. Some parents are ready for the trial, wanting to kind of spend that money and do it. And I actually have people come in because I do a lot of PGX testing compared to most of my peers in the community. So I get referrals because people say, hey, here is her approach. And so I get a lot of referrals based on that, too. And just out of your professional opinion, since you're utilizing it, how helpful do you find it? And oftentimes, does it help really determine things for you? So I wouldn't say particularly in ADHD cases because sometimes, you know, my thought on PGX testing is it helps with the pharmacokinetics and not the pharmacogenomics of it. So I can't say the medication efficacy based on it. I can only say what somebody can tolerate and how can I avoid the side effects and high dosing or low dosing. it. I often tend to use it in my depression patients, my anxiety patients, because that is a good way of looking at it. It's simplified. And the more we are data driven, the more people like to see it in red, yellow and green blocks to understand it better. So for me, the use is more based on compliance, because I think if you have more data to believe, if I had to walk more steps and I can see how those steps look like, it motivates me to be able to take it or motivates me to kind of be compliant with it. So that's what is more of a value to PGX testing in my practice. Saba, have you had a lot of experience with just kind of helping to implement that on a larger scale, especially with the more complex patients? Yes, especially with the same pharmacogenomics, that's the same approach, the same integrative approach. Whoever comes in, it's not like I'm going to just order a test for them. Whenever we are doing our vision histories, we have to determine the same thing, the cost effectiveness. And does it really work for them based on whatever conditions or whatever diagnosis they have? And especially in complex cases, yes, it does help because there are a lot of drug-drug interaction, a lot of drug gene interactions. There are a lot of, unfortunately, every time I meet the patient, although it's like a follow-up, I get to know more about them that they did not disclose in the first one. And then you understand, okay, that's what they miss. That's what they miss. So unfortunately, you know, at least 30% of the US population takes three or more medications. And at least now 98% of our population, they do have a pharmacogenetic variant that could be actionable based on whatever evidence we have. So whatever, when I worked with Dr. Khan, when we started, I told her, you know, I'm not going to go off like different labs. And I don't work with all of different labs. I work with ones that have validated gene panels. I'm not going to go with one that I'm testing like 50 genes because we don't have evidence for it. So what I told her was when you work with me, anything, any recommendation I put out on a paper, that will be backed up by evidence. That would be FDA and CPEC. And me being a CPEC member has helped me to look, I think, with a very different perspective because how we are included in all kinds of guidelines. And all of these are being actively implemented at Mayo Clinic and St. Jude's and so many other research hospitals all over the country. So yes, I definitely agree with we're talking about more complex cases. There are sometimes their parents, the same thing with ADHD. That's what we have seen because when I look at the patient population, it could range from early 20s to probably 70, 80s in that range. So most of the times what I see is the same thing with a lot of what Dr. Khan said and I love her approach. And that was one of the reasons I have both of us decided that it would be good for us to collaborate. A lot of the providers are using a very famous test out there and they would just look at the colors and just decide what is good for the patient, but not actually looking at the symptoms. And whenever we had a conversation, you know, you should not be just looking, even though the medication is probably in the yellow part or the red part, as they would like to call it. So, but we can always use those medications. We just need more monitoring for that patient so those are the things and what i loved about dr khan's approach was you know she's always willing to give it a try and anything that works she's always whatever recommendations i put out i do give my rationale and and i welcome any questions she has and then we taper based on you know based on the patient's symptoms and what is um there's one patient case that i would like to discuss as we go ahead in our discussion and yeah and that would just you know, help listeners and everyone to understand how we both work and how we both kind of collaborate to basically improve patient treatment clinical outcomes. So, yeah, no, I mean, that is interesting that Sabha's saying that that is where, while you take insurance, you're limited by the amount of time you have that you can really spend some time even with non-insurance patients. It's, there's so much you can cover in an appointment, which includes talking about your symptoms, really kind of doing the education part, explaining them lifestyle changes and all of this. And times, like Sabah said, they miss out telling us information. They forget to put their labs in all together. And there's so much a doctor can sit alone and try to do it. And where I use Sabah is, hey, this is a complex case, is on multiple meds. I do want you to kind of please look at this and review some of those things and give me a feedback. So it's all of this information that Sabah takes in, spends a lot of time with them, and gathers it and makes it comprehensive and precise for me to be more individualized with the treatment. And that itself is such a big benefit because I'm not thinking about reviewing that even if I ordered a PGX test, I'm not often sitting down for the same amount of time that Sabah would spend on explaining how those medications work in their body and how they interact with other meds. So now not only have I given this patient a precision individualized treatment option, I've also given this person a little more compliance opportunity because, you know, in psychiatry, the biggest struggle is not the meds, it's the compliance in so many ways. People, if they do not trust and believe in the medication, they're not going to take it. And if they not only hear from the doctor, they also hear from a pharmacist who's reviewed all of those medications, the labs, the interactions. there's a lot more improvement in compliance with medication. Oh, yes. And that's something I really want to highlight right here is the emphasis on you having your own personal medication advocate within the practice that you can lean on to really dive deeply because you're right. You are time constrained when you're visiting with these patients. There's only so much time that insurance allows for you to bill for. And that subsequently leaves you with less time being able to dive deeply into what some of these results can show. So I love that you have adopted this within your own practice. And I wish more practitioners would entertain this idea because this is time-saving for you. This is patient safety. This is being more accurate with selection. I mean, I love this. So I'm so happy that I get to share this. I don't want it to be necessarily, it's a unique relationship. I want it to be more prevalent all over. So that's why I want to share this with more practitioners where they see the utility of a pharmacist in their practice and how it can benefit them, really support you and just lessen your burden and your load. And Sabo mentioned that you guys want to talk about a real patient case. So I would love to dive in right now into a patient case with you guys that you've been able to work through together and just kind of give me the details. I want to hear about it. So this patient, I think we started collaborating in November, I believe, Dr. Kahn. And that was her first patient. So let's say she's, her name is A.B., a 54-year-old woman. And she was on multiple medications. And the reason she came was, Dr. Conreford was a polypharmacy. That was the biggest one because there were a lot of medications involved. So I'll talk mainly about the ones that we were able to change because there were a lot of them. The biggest one was she was on, and yes, and she had generalized anxiety disorder. That was the biggest one. Plus other ones that I don't think it would help in discussion. So the ones that were, she was on notriptyline. That was 10 milligrams. She was taking it three times a day. Then she was on Ambien, on extended release form. She was on metazapine, the extended release form. because she had been probably seeing a lot of, a couple of psychiatrists to her lifetime. And then probably a couple of months back, she started with Dr. Khan. And that's what I was able to gather. Then she was also, she was also on minoxidil and other kinds of medications, on weight loss medications. That was Manjaro. She has been on a Tesla for a while. She has also been using Xanax. that's one milligram three times a day or depending upon how she feels like four milligrams per day as well. Also taking Benadryl that's 100 milligrams every night at bedtime. These were the basic ones and yeah then they were also on Repatha for a while and they have been like continuously using Yes, yeah. And the Ketiapine as well, they were on... Yes so now I think she on probably 100 milligrams QHS That the recent one Yes yeah that the biggest one And there was all predom Yes yeah we did Yeah it was also ambient extended release And what we did was yes yeah And what we did was when we got her PGX test, it was interesting, Melissa. Let me, I do have everything here, so I don't mix anyone. So what it came out was CYP2D sex, because at least 25% of the medications, not just depressions like beta blockers, other antipsychotics, they do break down it's not just the only gene but it plays a major role as you know right so she was a poor metabolizer because due to a copy number variation so that was another thing because most of the labs would not classify a patient um based on whatever you know what their genotype comes out so what that's why i love the lab that i work with i can just reach out to them and just ask them can you tell me how many copy number variations does the patient have or how would you think could be classified as part of the patient, right? And that's big. Most of the lab would just hand you and just tell you, okay, we can't just classify, which is hard. Yeah. It's difficult for when you're trying to identify phenoconversion potential, especially with CYP2D6. Yes. And she was, so she was a poor metabolizer. She was okay for 2C19. She was a normal metabolizer. 3 or 4 was okay her 2c9 she was an intermediate and 2b6 was um normal metabolizer so for most of her what the basic thing to just keep it smaller what we did was since she was a poor metabolizer for 26 what i did um there were a couple recommendations that i had to keep it smaller for dr khan such easier for her to review with the patients so we simplified yes yeah so what we did was i recommended to taper down uh notaryl and then dr khan she did a great job in tapering her off it took couple of weeks and now she's totally off she um also we tapered off her on metazapine odt she was off eventually she just stopped and an interesting thing was um for the odt's and orally and disintegrating tablets she was just taking it just like just with water just as a tablet not allowing it to dissolve okay yeah so that would do those were a few things we talked about, but Dr. Khan was able to taper off those. Then we were able to stop her Ambien. That was a couple of months back. That's amazing. Then we finally convinced her, both of us, I would say, because she sees her, Dr. Khan, every week. And I think that kind of reinforces a lot of stuff. So we were able to take her off her weight loss medication because taking it once a month, because you have to be taking them consistently so the concentration builds up right so finally she decided okay i'm gonna take it and eventually um she tapered off that as well and um currently there are a few challenges but we are trying to still get her off her um um xanax and some of the other medications that chip because there are the stressors in their life so the best thing is we tried to take her off whatever we could with Dr. Khan's you know enforcement every week so she has been doing a great job with her sessions and still we but we do struggle with some of them and that will probably try to overcome in the next coming months hopefully as things kind of streamline in her life so hopefully those things will also but the best thing with this patient is least they're honest so when I talk to them did you stop these or did you stop these he was like no this is what is happening so I can't just stop it right now but the best thing is to actually acknowledge where the patient is and meet them or meet meet their goals where they are where they're at we're not just trying to push her to do something but we're trying to take off things that we can or what is easier for her and yes that helps huge improvement though I gotta say I mean, a lot of those medications, I would think, would bring some clarity and bring her out of a fog where she can do the work with Dr. Khan, right, in sessions where she can actually start working on the things that are provoking the use of the medications, right? I think she's a very brave patient, right? Because to have that honesty, and if you had providers and multiple providers sometimes giving you different prescriptions, and our clinic is very benzo opposed. I put that out really is benzodiazepines have a role, but it has a very short term role. But when patients are given by the family practitioners and things that they've been on it for years, it really is ineffective, but they are not able to give up on it because that's what keeps them going in a way. So having them to kind of engage in this, what are we doing? Are we crippling you towards dementia or something when you're clogging you with all of these sleep aids, these benzos, multiple polypharmacy? And I think sometimes it's hard to sort of just do it without, you can tell this all day long, but if you have something that the patients can see and have the conversation, there was cigarette smoking that was also affecting in our case and how that interacted and how all of that pharmacokinetics played with all the pharmacokinetics. Yes, with CYP1A2 activity, it can rapidly increase the metabolism of that, especially when we're thinking about psychiatry meds and antipsychotic therapies, for sure. And if that was the case, she probably was seeing some reduced effectiveness with certain things through her life if it was being utilized, if they're smoking consistently. That's something that people don't even think about is the environmental factors that have an impact on these medications and how they metabolize in the body, too. And the other one that was interesting is, Dr. Khan, I have a question about the GLP-1s in terms of when patients are utilizing it and the mental health impact. Have you seen a lot of patients just having a rough go at it when they are on either the higher dosages or on long periods of time? Because it can really mess with the gut microbiome. So I didn't know if that's something that you think about. You know, a lot of evidence is yet to be found on these medications and drugs. But as of now, there is room for some of that for kids who are actually having side effects with antipsychotics, especially the second generation antipsychotics, which seem to be very effective, but the weight gain is a problem. So we tend to recognize that and talk about it. Nutrition is a big part of how your brain functions. So if you're not eating, and what are you providing your body with? So certainly I think there's a lot more room to talk about it in so many ways. So there are benefits, but there are also so many cons with how it affects your gut microbiome and what you're doing about it. Yeah, for sure. Well, I love that you guys were able to collaborate with one another, really dive deeply into those medications for that patient and really just get them to a point where they're at one, not on what was the total of medications was it more well anything more than seven medications or five medications with polypharmacy so if we can get them more to that area that would be great i mean if we've been able to drop one two three medications right off four i know glp ones that is motivation from the patient the collaborative care that we've done to be able to drop four meds. And I remember being here in therapy session and she brought this whole bag of meds. It was very cathartic for her to say, I am going to drop this at pharmacy and I'm so excited to drop all of this. So yeah, I'm sure. I'm sure that was so liberating. Yes. Because after a while, when you're relying upon the medications, I don't like to say they're like a crutch or just like habitual. Sometimes, you know, like with patients with PPIs taking proton pump inhibitors. They just take them because it's just part of their daily routine and they may not even necessarily need to be on them anymore, especially with, you're right, it has to do with the patient and their openness to be able to do these things because then their mental mind shift is a lot easier to work with, I find. So I love that. But that's when Saba comes in, right? Oh, yes. That's when BGX testing comes in, in a way of, yes, you're not ready to listen to me, but here is some data for you to review and here's somebody who will explain this data to you. So you can actually follow through and understand this better. Oh, definitely. That's true. And just a little, like my two cents says, I think a patient feels comfortable when the clinician is willing to not judge them and are actually willing to listen. I think that's another thing. If Dr. Khan would have just, you know, just still, she kept on prescribing multiple medications, then she would have ended up in the same way that she was in the last couple of years. So I think a lot has to do with clinicians not judging and actually listening to what the patient is saying. Yeah, it might not be, there might not be a lot of evidence to everything, but at least clinicians who are willing to go a little bit deeper. I think that's what, that is what makes a difference. And that's why the relationship with a pharmacist is so important because you can break down that information for them because there is a stigma around pharmacogenomics. And there are a lot of laboratories that test for genes that don't have high levels of evidence. I agree with you there. And that's where it deters a lot of them from utilizing it. But also the sheer overwhelming information that comes on these reports. So for me, it's so crucial as a pharmacist whenever I'm interacting with any provider, when I'm counseling on the results, how they review the information, is really just to simplify it and make sure that they feel comfortable with how to digest the information, but also know that they have a resource to come to when they want to more deeply dive into the information. Because yeah, you're going to recall kind of the basics of everything, but being able to have the time is a huge thing. And that's where the pharmacist can really lift that weight for practitioners working in collaboration with one another. So this is that patient case is a prime example of it being implemented to perfection So I love that you were able to share that today with us for the audience because it just brings perspective on being able to work in a different way and not look to the. Sometimes I feel like when there's interactions with pharmacists and practitioners, it's almost like combative. They feel like we're trying to encroach upon things that they have expertise in and that we're trying to not be helpful, I guess. And that's why I feel like highlighting a relationship like this is so crucial to really more practitioners embracing collaboration with the pharmacist. And I'm just happy that you guys are having a good time doing it. I would assume you are. yes yeah and I think that's where you know um Dr. Khan's openness and her mindset comes in she's not because I work with a lot of different psychiatrists and primary care providers and functionalist practitioners so everyone comes with something but her openness um and be willing to work with different things so that I think that makes her very unique and not all of all the clinicians have it yeah they're very stringent about their mindset that's that's just experience and knowing that old models are not working anymore. There's a lot of mistrust in the medical community. We all need to collaborate. People like data. If we don't move into a different model that keeps our patients more individualized, away from side effects, compliant to their medication, then we all need to collaborate more. Yes. And forgive me, I didn't start our conversation like this, But I wanted to know exactly how you two came together in terms of just working with one another. Did you guys know each other from just from school or are you? I think I saw one of the physician friend of mine who had a son in my practice bring Sabah's report to my office. And that's how I got to find out about Sabah. She said, hey, I want to get my kid the best of treatment. And I went to Sabah and had this test done. And then we ended up getting on a phone call. And that's how I got to know Sabah first time. That's true. Yes. Patient, see, the patient brought it to you. And that is a, in my opinion, a great way for a door to open when trying to, for a pharmacist, kind of getting in with a practice and giving them some awareness around the value add, just kind of showcasing that in a medication action plan and giving you some insight into what they see as a perspective for you. I mean, I'm happy that you were open to it because a lot of practitioners will shy away. So being able to highlight this is, is, is crucial for pharmacists to be able to be looked at as a collaborator, a peer and a truly a, a tool to help you in these types of situations when we have polypharmacy kind of coming on board and even just moms. And I can't tell you how many times I've spoken with just parents about their children when it comes to just being terrified of starting medication. So they'll usually come to me to get testing first. And exactly the experience of you guys just meeting each other, it was brought to the psychiatrist, the practitioner prescribing, and then that conversation was had and then it just took off from there. So that makes a lot of sense. Let me tell you a random story, actually. It all starts with training, where you train and how they integrate pharmacists. And this is funny. I trained at UT Southwestern Child Psychiatry Fellowship at Austin. Now it's Dell. We had Dr. Taryn Smith, pharmacist with us, rounding in the mornings on an inpatient, telling us how to interact with medication. So it really kind of, it's odd. She was Dr. Smith too. yeah but it is uh she that's where i learned it she was part of our rounds and she would kind of go through all the meds the kids and that was just part of the training we had at ut i love that now del med school uh so that i think is going to be what all the at a school level i feel like it's being more implemented i went to school in colorado but i live in florida and i got to participate with Kaiser Permanente, and that is a preferred provider network where everybody is all under one umbrella. All the practitioners, the pharmacists, the clinical pharmacists are actively working in ambulatory care. So alongside the physicians who are prescribing and making adjustments. So I get what you're saying. It's about training where you go to school and what you involve yourself in. And older practitioners tend to be the ones a lot more apprehensive because they have their ways of doing things and years of experience, which I totally get. But I don't want them to feel afraid of utilizing such a tool to just better equip themselves with managing their patients. So this just makes me happy that you guys have had such a great experience so far. And hopefully you guys continue to work with one another. I would see it working that way. That's true. That's true. And I think that the biggest thing is, you know, most of the people, when they think of pharmacogenomics, it's, I think that's how portrayed it, that's how it is portrayed. It is not a silver bullet, right? We are using it as a tool, right? There's so many other clinical decision support tools we use. So we use it as a tool, not as something is going to just come in and just change everything. And you would know what medication you have to take. So I think setting expectations in the right way. And the same thing for the clinicians, just telling them what are the limitations, not just the good things, but the bad things and the other limitations that come with anything. Absolutely. And really, one last question I have for you both is where do you see integrative psychiatry heading in the future? Do you see stronger collaborations with this integrative model? You guys are kind of pioneering together here. and what really excites you about continuing to work together? You know, the pendulum has swung too far away in integrative approaches in some ways with all kinds of supplements, with no data, not FDA approved. And that worries me more because I have now patients who are really suffering and on 40 supplements and do not want to take antidepressants, but that could be more beneficial, any kind of medication, versus wanting to take 40 supplements. Plus, you don't even know how many of those 40 supplements are up to the standards, what kind of additions they have. And so there's no formulary that sort of checks on the quality, efficacy of these supplements. I think the more we kind of look at integrative approaches, I'm excited that that actually is being looked into, and maybe we'll find a medium ground on what that would look like in terms of, yes, there's more holistic approaches. How are we talking about lifestyle changes? What are we talking about sleep and appetite? Adults with screen times and what does that look like? Yes, your sleep habits in general. Are you blaring a TV in your phone in front of your face right before you're going to bed? Yeah, that's going to impact how you fall asleep at night for sure. And then we can take three medications for it and five supplements to hope that that will fix it. Mm-hmm. Mm-hmm. No, I agree. I agree. I'm hopeful. I feel like we're talking more about nutrition, health, what these supplements mean and which supplement is good for you and which is not, and be more effective with that. So I'm excited about what integrative psychiatry is going as it kind of finds this new balance. I'm glad you mentioned about the supplements because you're right. So many people are trying to supplement themselves to death in hopes of curing things and helping with things. And yes, there's a time and place for certain supplementation, but my philosophy is less is more and being very targeted and very mindful of what you're taking and not just throwing the kitchen sink of supplements at yourself because they could also be causing issues for you in terms of there is drug to drug interactions with certain things. St. John's court, great one to bring up because that one does interact with a lot of the antidepressants and things like, and things of that nature, but also, um, to three, four in particular. So that's a big one we always learned in pharmacy school. But in terms of, let's see here. Anything that you're excited about when working with each other, Saba, before we kind of sign off today? I think I really appreciate her openness and mindness. So I'm excited to, you know, help more people because I know we have so many people who are struggling. So I look forward to working with Dr. Khan on other complex cases so we can come back. and tell you how many patients that we were able to help. And yes, yes. So that's the biggest thing. And yeah, I really appreciate the opportunity. Amazing. Well, I want to thank you both for joining me here today on this episode. And just thank you so much for sharing your story, your collaboration with one another, your patient case that was just so powerful to hear about in terms of being able to remove at least three medications off their roster. That's amazing. And just thank you for being here. I appreciate it very much, more than you know. Thank you, Melissa. Thank you for doing this education podcast. So important. You're welcome. So you're so welcome. I'm so glad I was able to have an MD on with me today, as well as another pharmacist. So this is bringing perspective to all of my audience listeners when it comes to just utilizing precision medicine, looking things in a different way, and just knowing that it's helpful. Thank you.
