Why most methylene blue cases came from anesthesia, not pills
Most patients on antidepressants are told they can't take methylene blue, even for brain fog. Steven E. Warren, a physician and longevity medicine clinician, joins Kevin to discuss his KevinMD article "51 cases that reframe methylene blue serotonin syndrome." You'll hear why 50 of the 51 published serotonin-syndrome cases involved high-dose IV methylene blue given under anesthesia, mostly during parathyroid surgery, rather than the low oral doses used in outpatient longevity practice. Steven walks through the Goldilocks dosing posture he uses for patients with brain fog, why he screens every patient's full medication list for interactions before starting, and why he tells every patient there are no randomized trials behind methylene blue. He also describes the broader longevity practice he sees daily: patients stacking peptides from the gym, megadosing vitamin D from podcasts, and ordering supplements off Amazon without quality control. If you're a clinician fielding methylene blue questions or a patient considering it, listen for the questions Steven thinks should be asked before starting any unstudied supplement.
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