I started taking Nardil and Parnate about ten years ago and never looked back. It's just silly the oldest and most effective medications for depression aren't in wide use. It's just the silliest thing.
@@brendonmclachlan5462 ah thats good to hear. I wanted to maybe try out an Maoi but im still a bit sceptic because of bad experiences i had with other drugs like SSRIs
@@herbertgoldstein1156 I just started parnate three weeks ago, having been put on various SSRI’s I’m now only getting true relief from depression. The side effects have been very manageable.
Please let this get more attention, this is real So many psychiatrists don't even know about anhedonia, nor do they distinquish between depressive disorders Depression and specifically anhedonia has taken 4 years of my life away and I am hoping MAOIs might help me take back the rest of my life
Have you had any success? Which medication are you trying? If it was parnate, did you have intense fatigue at the beginning? Do you have to escalate the dose quickly to avoid that? Sorry about all the questions, any info is so helpful.
Ive had anhedonia for ten years now. Antidepressant adverse reaction along with stress and trauma became a perfect storm and like short circuited my brain. I've been trying everything since to fix myself and I have gotten so little actual support from the people in the field. I actually stumbled on MAOI talk on Reddit and saw selegiline transdermal had less restrictions but some people had major improvement on it. I brought it up with my doctor (she KNOW how damn HARD I've been fighting to survive, how much effort I put in and research to help myself). She said it was an old drug and they hardly ever prescribe the old ones. She was totally willing to give it a shot but warned me she has limited personal experience with the class of drugs. I had been on Wellbutrin and Adderall. The Wellbutrin helped a little (which is a lot when you are so seriously messed up), till it plateaued. I've been taking the patch for a little over a week now and I can feel stuff happening. It's like a very slow thaw. I am scared to get my hopes up because I desperately do not want another let down. What I would like to understand is, if these drugs are so effective, why aren't they perscribed? Is it because they are out of patent, or because of the severity of interactions cause liability issues...? Because it is cruel to let people who are in a state of perpetual existence, and nothing more, waste YEARS of their lives with so little hope when there are actually drugs that are effective collecting dust on a shelf while newer drugs are offered. Drugs with much more debilitating side effects. I would rather die quickly of a heart attack than go another ten years with weight gain, confusion, horrifying dreams, night sweats, flatlined emotions or rollercoaster emotions, etc... I have been raising three kids as a single parent for ten years and I know my hell has impacted every single day of their lives. So not offering treatments to people that could save their lives feels genuinely cruel. Doctor, thank you for educating and advocating. From the bottom of my heart.
@@sarahmunromaddonna6264 You are right, it is cruel. The most infuriating and cruel part of anhedonia though is how little is known about it, and how I literally can not imagine what other disease is worse. Any disease that makes your life miserable physically, mentally or both will eventually make you depressed and probably somewhat anhedonic. But when anhedonia "stands alone" it is like cutting straight to the most horrible part of any bad experience, and then staying there until you figure out what is causing it, which is stupid difficult because nobody knows anything and we're barely able to help ourselves. In my honest opinion something that makes you want to die for years on end is way worse than something that actually kills you. Luckily it seems research within the field is increasing and I believe it is only a matter of time before anhedonia becomes widely known as one of the worst mental illnesses. I don't know if you meant to reply to my comment because it doesn't seem directed at me but perhaps I can be of some help although I probably can't. After I wrote my comment about a year a go, I got to try the MAOI called Marplan and it did nothing for me just like every other drug. I came to the conclusion that drugs was never going to work for me and I felt horrible. I just lost all hope of getting better. At the same time I realised that there were things I could do on my own like eating more than 1 meal a day. I want to fix what I can without drugs and see how far that gets me. I am hoping I've just been an idiot and not realised that there were a bunch of things I could be doing to get my life back. Right now all I've been able to do is eat 3 meals a day like a normal human being and it has been a much bigger journey than I thought. It's been extremely miserable, I've lost all the energy I had and more, but it seems like I'm just very slowly getting better over time. Even if this doesn't bring me to the end of the rainbow, it was still neccessary to increase my food intake before trying anything else. A very helpful guy on reddit made me aware that without enough nourishment, your brain simply won't have the resources it needs to produce the neuro-transmitters (or whatever the fuck it is) that makes you feel happy. So drugs or not eating enough comes before anything else to me now. I know this may not directly apply to you, but there's a chance it does, and there is a chance that it helps you figure something out on your own. Either way I hope I could at least give you some hope that even if you can't find a drug that works for you that maybe you find another way. We humans seem to be very dumb but way too persistant to just roll over when there is still something we can do, even if we aren't conciously aware of it. Also if you have any questions or anything feel free to ask, if no psychiatrists or psychologists know how to help us the we'll have to try and help eachother.
@@gregorymalchuk272 Hey I'm so sorry that I didn't reply. I guess I didn't realise someone had replied to my comment back then. I tried the MAOI called Marplan. I barely remember the experience of taking it and I mostly just remember it being shitty and making my mental state overall worse. So in short I haven't had any success with drugs and I believe it has been because of how little I've been eating. I just wrote a reply to Sarah Munro Maddonna who also replied to my initial comment, I go a bit into what I've been doing the last 5 months now that I have given up on medication. I just checked what I wrote down about the drug and this will most certainly be way too late, but getting off Marplan was actual anxiety hell. It is one of the reasons why I'm just done with medication, it has never helped me and sometimes the side effects are like taking a trip to hell or being awake during a nightmare. I'd be happy to answer any and all your questions, wether they're about medication or other stuff. I hope you've managed to get better since you wrote your comment and that you didn't have the same experience with MAOIs that I had if you got to try one.
You're right, if the doctors won't or can't help us then we have to help one another the best we can. Because life isn't living when you are stuck in survival mode. I've been taking a mushroom complex which I think helped me some. I don't know if I should continue it or if it could interact with the Selegiline patches, but maybe you could look into one of them. Reddit has a broad mix of good info and bad, so you have to be careful. I wish eating enough was my problem. Since I stopped Wellbutrin I've been eating out of boredom. It's great you have gotten progress though. I have been struggling with drive. I want and NEED to do so much but I don't have the motivation. Which makes me feel worse because I am not one for sitting around waiting for others to fix my problems. Anyways, thanks for writing back. I didn't know if anyone would see it. Take care. ♥️🥰
Thanks for your amazing work Dr. I'm in Cairns myself and was on Parnate years ago. Got an appointment today and hopefully will be put back on it for my depression alongside my dextroamphetamine for my ADHD. I hope my brain swims in dopamine again as a result of this. Whilst the stimulant can provide great short term relief of my symptoms, it unfortunately causes unpleasant emotional volatility which I hope the Parnate will address. Cheers!
Dr Gillman, thanks as always for your tireless efforts to keep MAOIs relevant. Almost all doctors I have consulted have dogmatically refused to consider prescribing an MAOI alongside commonly used ADHD stimulants. For those whose depression and ADHD are comorbid, what would your advice be to convince such a doctor to consider it? I understand reuptake inhibitors such as methylphenidate and the prodrug form of dextroamphetamine to be relatively safe, if the dose is properly titrated.
Very good video. Quetipine and other dopamine blocking agents have always made my depression far far worse, despite this consultants still push them onto me. I refuse to take these anti dopaminergics anymore they are exacerbating an already incredibly incapacitating condition. I feel cheated by psychiatry. Even the SSRIs, you can't feel any emotion, number to the point of irrelevance. More research on dopaminergic promoting drugs needs to be urgently carried out.
Yes, we agree. I've just done the commentary and the video concerning how RCTs have misinformed everybody about the supposed AD properties of SSRIs, and all of other drugs. Hopefully Heidi will be well enough to deal with those soon
I am retired, there is nothing I have to do, nothing I should do, but all sorts of things I could do! My retirement motto is "Rien n'est importante". If you could afford to pay for me to have a part-time secretary I could do a lot more!
@@psychotropicalresearch5653 Dr Gillman, perhaps you are not quite aware of the level of following you have online now, particularly on Reddit. You could get this crowdsourced (paid for by many people contributing) in 5 minutes if it would help your research.
@@RahulGupta-uq3jz Thx for that. We are working away hard to do all sorts of stuff and that, and similar,is on the list. Anything you can do to help... contact the 'CYPs' (see website)
I'm So glad I found you Dr Gillman! I really want to go back on Nardil which is the one med that helped me the most. I regret getting off of it. The last two years I've been undergoing one med change after the next but nothing really seems to work. I'm afraid of the washout period that I will have to undergo before reinstating. 😰
These questions are answered in various places on the website and in the benchmark guidelines paper we have published - there is a link to the free download that paper on the homepage of the website and a few utilise that you might could contribute to the cost of publishing it was thousands of dollars
Thanks for your work Dr. We spoke last week. I had only heard about this stuff last week. I have a good dr who was more than happy to prescribe Phenelzine Sulphate; luckily; he even commended me on being proactive (he is very aware of issues with drug companies/ PBS etc... But, it's true, I am a bit worried to find that i can only find 1 bottle of 60 15mg tablets in Sydney. A company is making them, but they are out of stock for a few weeks. It's a very worrying situaion for those who are on them.
Hello from Portugal ! First of all, love your videos, very informative and science based that i always look for. I am a 37 female recently diagnosed with adhd - innatentive. Since i remember myself i have always been kind of low mood / flat mood and with no much motivation to move (unless it was a novelty , then i would have high energy) , anyway, i have been looking and i dont think MAOI are used in my country. I am using Elvanse (Vyvanse) for almost a year now and even though i love it mood wise i dont think it has made me quite "there" yet . I am used to having this flat mood without many emotions going on , motivation is better, sleep is better but i wonder if serotonin is lacking. If so, how could i go about this ? What antidepressant could work well with something like Vyvanse (dopamine and noradrenaline) ? I am scared of the low libido side effects of most , my libido is null . Thank you if you happen to take the time :)
Good evening, esteemed colleague Dr Gillman. I am an Italian psychiatrist (Dr Nicola Mosti, from Pisa, Tuscany) and I have a couple of patients on Nardil therapy, the only drug among many that they have benefited from and through which they have been in remission for years. Among those who suffer from treatment-resistant depression, however, I also have some patients who have not responded and/or who do not tolerate MAOIs. In these cases (atypical depression with prevalence of anergy, anhedonia and demotivation) I have had good results with pramipexole. However, I must confess that I am a little troubled by the prospect of having to use it on them for a long time. What do you think of this drug? My best regards and the utmost respect for its valuable activity. 🙏
Off topic, but I would like to hear your opinion on Tianeptine, I didn't find info in your webpage. As someone who has tried around 15 different antidepressants, I'm sick of being prescribed useless SSRI's that worsen my symptoms and no doctor is willing to pescribe me Tianeptine because (in their own words) "we don't know much about this paritcular med, never used in any patient". They have a similar attitude towards MAOIs, even when I show them papers, all they want to do is to stick to SSRIs, the newest ADs like vortioxetine and MAYBE some tricyclics at best. I feel betrayed by great part of the psychiatrist community, many of them don't seem to care enough about patient's wellbeing. What makes it more ludicrous is when they have no problems trying to give me high risk meds like clozapine, but they are so reticent about prescribing tianeptine. Thanks for your videos, as always, very informative.
@@psychotropicalresearch5653 Do you understand the issue here ? People who are prescribing rarely watch or hear or try to hear what you are saying. And, patients keep suffering. Demand is not based here on consumers, its on doctors, agencies .... Its far from possible for patients to get listened and push for demand. Dont be in the dilemma of - Something is better than nothing. Its actually nothing as long as Doctors listen.
@@psychotropicalresearch5653 I was just asking for a brief opinion, not a dense discussion or article about it. Two senteces would suffice, or a citation to a source that summarizes your thoughts about it if you happen to have one. If this is a subject that you consider unable to be covered in the comment section of youtube, OK , I understand that. It is not my intention to waste your time.
@@bhaskartaneja6293 Bhaskar, I’m not sure how well people will understand what you are trying to convey here, nor indeed were ‘here’ is, but I conjecture you are in India? I write for a very international audience and I certainly apologise if I have insufficient knowledge of the considerable differences in the culture and medical systems in the countries of the various people who might read my work or listen to my videos. I sometimes think that people in America write and behave as if the rest of the world did not exist, and I certainly would not want anyone to think that sort of thing about what I do. If you have any ideas about how to increase awareness and usage of these drugs in your area them to do please communicate these to us, preferably to Heidi at PsychoTropical. You say ‘Dont be in the dilemma of - Something is better than nothing. Its actually nothing as long as Doctors listen.’ - perhaps you could explain about that a bit more? I may not be the only one who does not quite understand it. The response section is not really a venue for complex and abstruse peripheral considerations of issues in videos.
@@Megaghost_ perhaps what I should've communicated was that I do not have any experience of using that drug nor any depth of special knowledge about it so do not feel I'm qualified to offer any kind of expert opinion about it.
What are your thoughts about letting depression heal on its own living a healthy lifestyle ? If depression is stress induced why would it not be able to heal on its own considering stress reduction techniques ?
Because a lot of times biology is too powerful. And even if you can heal with alternatives, a lot of time there is not time. The person will inflict harm of committ suicide before any natural therapy works. What you are asking is like asking "Why don't we let someone with multiple bullet wounds heal naturally?" The answer is that the person will die from shock and blood loss much before any healing can happen.
Illness is illness is illness. If you had serious anemia of the blood you would not be asking such a question. depression is not “just a state of mind “, it can be an abnormality of brain function, like epilepsy.
@@elazarziv8217 how do you fake a prescription? I'm sure you would be in all kinds of trouble if you got caught but at the same time I can understand how a person might be desperate enough to do that.
Good day, Dr. Gillman. Thank you for such significant for science and patients information! I have dysthymia, fibromyalgia and hypoactive sexual desire disorder. I used to take milnacipran, it worked great for me, I become much more active and effective, pain go away, but my HSDD didn’t go away. I quit treatment with milnacipran 5 month ago and my depression coming back. Can IMAO be more effective for dysthymia, fibromyalgia and HSDD? Can I get longer remission with IMAO?
@@trynalive4373 the usefulness of the answer can only reflect the usefulness of the question! For some people yes, for others no! Read my review paper on TCAs.
These questions are answered in various places on the website and in the benchmark guidelines paper we have published - there is a link to the free download that paper on the homepage of the website and a few utilise that you might could contribute to the cost of publishing it was thousands of dollars
Hi Dr, if someone was in my shoes and had severe social anxiety, moderate generalized anxiety, and mild depression but couldn't be put on an MAOI would Sertraline be a good SSRI to try or is there something else you would recommend them?
@@ve_rb It doesn't matter how selective a SSRI is; what matters is how potently it inhibits serotonin reuptake, and escitalopram is quite potent at it. Therefore, ES would absolutely, 100% cause serotonin syndrome if you take enough of it. You really shouldn't be giving advice to people. You can get them killed.
I imagine you are alluding to the fact that sertraline is a weak dopamine reuptake inhibitor, if you look on the website you will find information on this issue
@@psychotropicalresearch5653 Sorry I missed your comment. I put a timetamp to see it again. Is sertraline´s effect on dopamine strong enouh to have antidepressive effects?
Probably not, or at least it would be very minor. Quality control and bioequivalence regulations are pretty tight. However, it does seem that phenelzine is the exception to this. The number of people reporting differences between the various preparations that have been available do seem to be significant.
@@psychotropicalresearch5653 Thank you very much for your anwer. I read some revieuws from people from the Netherlands who made the switch and felt different. But maybe its just those people who react online. Im gonna start 1 september. Can parnate also help with adhd and cognitive functions? Is Sertraline, i never tried it but i read you say its a good ssri? I react also pretty good to wellbutrin. So still thinking maybe wellbutrin and sertraline is a good option
I had akathisia and jerking in my limbs from Prozac and it really scared me from trying something after that. I was wondering if MAOI’s have a high incidence of akathisia?
As with most comments on the UA-cam channel my responses is to go and look at the website which contains far more information -- but no, phenelzine is not gone, there is a special section about this on the website -- go look
Yes Luke, it does have a modest dopamine boosting affect, but with a fairly low ceiling as far as the overall magnitude of the effect is concerned, otherwise it would make schizophrenia worse not better. Again, you'll have to wait for part two
PsychoTropical Research thanks for your reply doc. I also wanted to know would MAOI medications be useful for those who are addicted to dopaminergic drugs such as Adderall?
@@lukeraynor3704 No. *Nothing* elevates dopamine as much as cocaine and amphetamines. If that is your problem, a very slow taper is the best solution. but you can try rasagiline + tolcapone after withdrawal. But since tolcapone is very toxic to the liver, you will have to do that under a doctor's supervision. Your problem has nothing to do with depression. There used to be some slow-binding DRIs in the past like amineptine and nomifensine that could help you, but these drugs have been removed due to a few cases of abuse and addiction, so you will need to face withdrawal cold turkey.
I got that its dopamine.. but isn't there a way to address why suddenly people start having low dopamine , essentially being depressed. Dopamine deficiency is the effect that has cascading effect with other symptoms - not the root or initial cause. Or once corrected dopamine, body will get better , that's never the case. Hooked on MAOIS forever. Also how one will tackle insomnia who has already got that with snris and ssris, considering Parnate and other MAOIs have substantial insmonia component. Benzos and Antipsychotics cause memory loss... Their dependency has other severe effects. Also thus the question arises on how to stop only on 1 or 2 drugs rather than making a cocktail of side effects for patients - keeping down one's side effects by adding another severe chemical. What about Pramipexole?
@@psychotropicalresearch5653 Did I hurt your doctor ego ? Showing people that you studied much more , but cannot give an easy answer. I have been a 1st hand subject for 10s of SSRIs, SNRIs, APs, Benzos and made to suffer. The withdrawals were hellish. Leaving them made me fatigued, stiff body, congestion, blurry eyes, feeling different from me, memory The same answer were given by so called experts that I had gone to - "We are the experts. We studied. ". You are no different.
@@bhaskartaneja6293 You are acting like a complete jackass. Sometimes your body develops a deficiency of certain hormones and the only solution is to take hormone replacement therapy because there is no other way to make your body produce it. How would it be different to take something to help keep dopamine elevated if low dopamine is the cause of your depression..? Are diabetics "hooked on insulin" or what? You get dealt the cards you do in life, if you are given a chronic incurable disease then you have to make the best out of it. For people with diabetes it could mean using insulin for the rest of their lives. For some people with depression caused by low dopamine taking a MAOI, stimulant or dopamine agonist or whatever else for the rest of their life. You have to understand that depression/low dopamine can also exist as a chronic incurable disease just like type 1 diabetes where the only solution is management/"replacement therapy". Why the fuck do you think low dopamine can't exist like a disease like low/no insulin, low/no thyroid hormones, low/no testosterone etc?? And just like Gillman says I can guarantee you that if you manage to find a solution to low dopamine that doesn't involve the use of drugs you could become a billionaire. :)
@@jacobski7216 You are 100% correct. A lot of people don't understand that genetics is the *primary* determinant of who you are. Genetics is not destiny, but it is close to destiny. Teh power of genes can be demonstrated by people that have congenital. hypercholesterol. Without cholesterol-lowering drugs like statins, they develop heart disease and die in their thrities and forties no matter what they do. Even if they eat nothing but green salads and exercise every day, their arteries still get clogged, and they die of myocardial infarction in their forties. Conversely, one of the genes found in super-centenarians is a gene that heps to make massive amounts of HDL, the "good" cholesterol. These people *never* develop heart disease, even if they are sedentary and eat pork fat every day of their life. Conversely, the poor sap that was born with shitty genes will eat steamed broccoli and run 10 miles a day, and still die from a heart attack. Life is not fair. life sucks. Fro instance, some people are born with a mutant version of the COMT gene that makes them exceedingly happy. They have at least 60% higher dopamine throughout their brain than regular people. They report over twice the positive emoptions of the average person. No matter how terribly life treates then, they still can't help but seeing the positive side of things. On the other hand, some people with chronic depression and anhedonia just didn't luck out. for instance, some people are born with an "over-zealous" version of the dopamine transporter that cleans off dopamine from the synapsis much faster than usual. Others are born with the val-val version of the COMT gene, which breaks down dopamine very effectively. This leads to despondancy, pessimism, mental fogginess and despair. According to this guy, this person should just try to undergo therapy to address the "root" cause. but the root cause is biological. The person will feel like ST even after 20 years of therapy because talking can't overcome an invincible genetic program. Conversely, popping a pill that changes the way that the physiology of dopamine works works instantly. And we know that it works instantly, as anyone who has ever taken amphetamines or drugs that elevate dopamine a lot and very fast know. A lot of damage is done in this World by people that believe that modern medicine is fraudulent and that we should return to a more "natural" life. This is know as "the naturalistic fallacy", where people think that Nature is better and that men screws up. But Nature did not design us to be super-happy or super0healthy, but rahter just to breed. Some people just get the worst genes. People can't accept this because they don't find it fair. but life is not fair.
@@psychotropicalresearch5653 sir by mentioning bupropion and sertraline do u say that we can try these if we don't want to take maoi and secondly i heard that withdrawal from maois is really very horrible n painful.
If dopamine is what missing why do stimulants in a lot of studies not improve depression when SSRI/SNRI are augmented with them. What is your experience augmenting with them ? Btw, great channel.
Good question but much too complex to attempt to answer here. Please feel free to Skype and if you can catch me when I have time I will try! Quick answer, it's probably a question of balance.
Stimulants are not effective at substantially increasing dopamine signaling evoked by brain activity... As the dose gets higher, it becomes less 'pulses' of dopamine and more a flood. But the low doses aren't strong enough. The high doses work at first (stimulant induced mood lift, what recreational users seek) but the brain compensates. Why? Because the brain interprets dopamine signals in relative ways, so if it sees a constant increase, it just resets its baseline. MAOIs are better because they can powerfully enhance dopamine pulses without flooding the brain. Stimulants continue to work for ADHD because the prefrontal cortex doesn't care as much about the ups and downs of dopamine, as the reward areas do.
Taking a diamine oxidase (DAO) enzyme supplement with wine helped me with the malar rash. Prevents dietary histamine absorption. Or drink cheaper wine, hahaha.
Your personal simplistic view about alcohol is not going to help anyone, and as Paracelsus said “What is there that is not poison? All things are poison and nothing is without poison. Solely the dose determines that a thing is not a poison,”
@@psychotropicalresearch5653 ok, its the your view, but no one as alcohol have ruined so many lifes and its my own experience and view.. So.. I can say more but my english is not enough good for that) peace, bro! Using selegeline is better even for the doctor!
Dopo l'uscita di produzione di Parmodalin, con cui ho condotto per anni la vita di una persona normale ho subito un crollo dal quale non riesco piú a uscire nonostante da allora mi continuino ad essere prescritti antidepressivi e altri psicofarmaci che risultano del tutto inefficaci. I farmaci acquistati all'estero mi sono stati ripetutamente bloccati in aeroporto e avviate procedure burocratiche che richiedono mesi perché il pacco di sblocchi. Alla fine ho dovuto rinunciare anche a quell'opportunitá. Impossibile immaginare una situazione piú assurda di questa.
Gilman is Revitalising the dead from the grave one at a time, Viva la MAOI society
I started taking Nardil and Parnate about ten years ago and never looked back. It's just silly the oldest and most effective medications for depression aren't in wide use. It's just the silliest thing.
are you still taking it ? greetings
@@herbertgoldstein1156 Parnate I am yes
@@brendonmclachlan5462 ah thats good to hear. I wanted to maybe try out an Maoi but im still a bit sceptic because of bad experiences i had with other drugs like SSRIs
@@herbertgoldstein1156 they are good for eliminating depression
@@herbertgoldstein1156 I just started parnate three weeks ago, having been put on various SSRI’s I’m now only getting true relief from depression. The side effects have been very manageable.
Please let this get more attention, this is real
So many psychiatrists don't even know about anhedonia, nor do they distinquish between depressive disorders
Depression and specifically anhedonia has taken 4 years of my life away and I am hoping MAOIs might help me take back the rest of my life
Have you had any success? Which medication are you trying? If it was parnate, did you have intense fatigue at the beginning? Do you have to escalate the dose quickly to avoid that? Sorry about all the questions, any info is so helpful.
Ive had anhedonia for ten years now. Antidepressant adverse reaction along with stress and trauma became a perfect storm and like short circuited my brain. I've been trying everything since to fix myself and I have gotten so little actual support from the people in the field. I actually stumbled on MAOI talk on Reddit and saw selegiline transdermal had less restrictions but some people had major improvement on it. I brought it up with my doctor (she KNOW how damn HARD I've been fighting to survive, how much effort I put in and research to help myself). She said it was an old drug and they hardly ever prescribe the old ones. She was totally willing to give it a shot but warned me she has limited personal experience with the class of drugs. I had been on Wellbutrin and Adderall. The Wellbutrin helped a little (which is a lot when you are so seriously messed up), till it plateaued. I've been taking the patch for a little over a week now and I can feel stuff happening. It's like a very slow thaw. I am scared to get my hopes up because I desperately do not want another let down.
What I would like to understand is, if these drugs are so effective, why aren't they perscribed? Is it because they are out of patent, or because of the severity of interactions cause liability issues...? Because it is cruel to let people who are in a state of perpetual existence, and nothing more, waste YEARS of their lives with so little hope when there are actually drugs that are effective collecting dust on a shelf while newer drugs are offered. Drugs with much more debilitating side effects. I would rather die quickly of a heart attack than go another ten years with weight gain, confusion, horrifying dreams, night sweats, flatlined emotions or rollercoaster emotions, etc... I have been raising three kids as a single parent for ten years and I know my hell has impacted every single day of their lives. So not offering treatments to people that could save their lives feels genuinely cruel.
Doctor, thank you for educating and advocating. From the bottom of my heart.
@@sarahmunromaddonna6264 You are right, it is cruel. The most infuriating and cruel part of anhedonia though is how little is known about it, and how I literally can not imagine what other disease is worse. Any disease that makes your life miserable physically, mentally or both will eventually make you depressed and probably somewhat anhedonic. But when anhedonia "stands alone" it is like cutting straight to the most horrible part of any bad experience, and then staying there until you figure out what is causing it, which is stupid difficult because nobody knows anything and we're barely able to help ourselves. In my honest opinion something that makes you want to die for years on end is way worse than something that actually kills you. Luckily it seems research within the field is increasing and I believe it is only a matter of time before anhedonia becomes widely known as one of the worst mental illnesses.
I don't know if you meant to reply to my comment because it doesn't seem directed at me but perhaps I can be of some help although I probably can't. After I wrote my comment about a year a go, I got to try the MAOI called Marplan and it did nothing for me just like every other drug. I came to the conclusion that drugs was never going to work for me and I felt horrible. I just lost all hope of getting better. At the same time I realised that there were things I could do on my own like eating more than 1 meal a day. I want to fix what I can without drugs and see how far that gets me. I am hoping I've just been an idiot and not realised that there were a bunch of things I could be doing to get my life back.
Right now all I've been able to do is eat 3 meals a day like a normal human being and it has been a much bigger journey than I thought. It's been extremely miserable, I've lost all the energy I had and more, but it seems like I'm just very slowly getting better over time. Even if this doesn't bring me to the end of the rainbow, it was still neccessary to increase my food intake before trying anything else. A very helpful guy on reddit made me aware that without enough nourishment, your brain simply won't have the resources it needs to produce the neuro-transmitters (or whatever the fuck it is) that makes you feel happy.
So drugs or not eating enough comes before anything else to me now. I know this may not directly apply to you, but there's a chance it does, and there is a chance that it helps you figure something out on your own. Either way I hope I could at least give you some hope that even if you can't find a drug that works for you that maybe you find another way. We humans seem to be very dumb but way too persistant to just roll over when there is still something we can do, even if we aren't conciously aware of it.
Also if you have any questions or anything feel free to ask, if no psychiatrists or psychologists know how to help us the we'll have to try and help eachother.
@@gregorymalchuk272 Hey I'm so sorry that I didn't reply. I guess I didn't realise someone had replied to my comment back then. I tried the MAOI called Marplan. I barely remember the experience of taking it and I mostly just remember it being shitty and making my mental state overall worse. So in short I haven't had any success with drugs and I believe it has been because of how little I've been eating. I just wrote a reply to Sarah Munro Maddonna who also replied to my initial comment, I go a bit into what I've been doing the last 5 months now that I have given up on medication.
I just checked what I wrote down about the drug and this will most certainly be way too late, but getting off Marplan was actual anxiety hell. It is one of the reasons why I'm just done with medication, it has never helped me and sometimes the side effects are like taking a trip to hell or being awake during a nightmare.
I'd be happy to answer any and all your questions, wether they're about medication or other stuff. I hope you've managed to get better since you wrote your comment and that you didn't have the same experience with MAOIs that I had if you got to try one.
You're right, if the doctors won't or can't help us then we have to help one another the best we can. Because life isn't living when you are stuck in survival mode. I've been taking a mushroom complex which I think helped me some. I don't know if I should continue it or if it could interact with the Selegiline patches, but maybe you could look into one of them. Reddit has a broad mix of good info and bad, so you have to be careful. I wish eating enough was my problem. Since I stopped Wellbutrin I've been eating out of boredom. It's great you have gotten progress though. I have been struggling with drive. I want and NEED to do so much but I don't have the motivation. Which makes me feel worse because I am not one for sitting around waiting for others to fix my problems. Anyways, thanks for writing back. I didn't know if anyone would see it. Take care. ♥️🥰
Thanks for your amazing work Dr. I'm in Cairns myself and was on Parnate years ago. Got an appointment today and hopefully will be put back on it for my depression alongside my dextroamphetamine for my ADHD. I hope my brain swims in dopamine again as a result of this. Whilst the stimulant can provide great short term relief of my symptoms, it unfortunately causes unpleasant emotional volatility which I hope the Parnate will address.
Cheers!
That combination requires care and caution, and make sure if you located Dr up there who is MAOI compliant get them to join my expert group
@@psychotropicalresearch5653 hi Dr! Already taken care of. :) my psychiatrist told me he contacted you, dr Matthew Hocking of Brisbane
@@sashatagger3858 I do not recall that name, could you make sure he has done that or provide me with his email address?
@@psychotropicalresearch5653 sure!
@@psychotropicalresearch5653 give me a while sir. :)
Dr Gillman, thanks as always for your tireless efforts to keep MAOIs relevant. Almost all doctors I have consulted have dogmatically refused to consider prescribing an MAOI alongside commonly used ADHD stimulants. For those whose depression and ADHD are comorbid, what would your advice be to convince such a doctor to consider it? I understand reuptake inhibitors such as methylphenidate and the prodrug form of dextroamphetamine to be relatively safe, if the dose is properly titrated.
Thank you so much for this video! You're a very smart man.
Very good video. Quetipine and other dopamine blocking agents have always made my depression far far worse, despite this consultants still push them onto me. I refuse to take these anti dopaminergics anymore they are exacerbating an already incredibly incapacitating condition. I feel cheated by psychiatry. Even the SSRIs, you can't feel any emotion, number to the point of irrelevance. More research on dopaminergic promoting drugs needs to be urgently carried out.
Yes, we agree. I've just done the commentary and the video concerning how RCTs have misinformed everybody about the supposed AD properties of SSRIs, and all of other drugs. Hopefully Heidi will be well enough to deal with those soon
I was also given quetiapine which made my depression worse. Did u try abilify? Profy? Do it make better or worse like quetiapine?
You should add something on pramipexole in your next video. I've read good things in regard to depression.
did it help it?
I am retired, there is nothing I have to do, nothing I should do, but all sorts of things I could do! My retirement motto is "Rien n'est importante". If you could afford to pay for me to have a part-time secretary I could do a lot more!
@@psychotropicalresearch5653 Dr Gillman, perhaps you are not quite aware of the level of following you have online now, particularly on Reddit. You could get this crowdsourced (paid for by many people contributing) in 5 minutes if it would help your research.
@@RahulGupta-uq3jz Thx for that. We are working away hard to do all sorts of stuff and that, and similar,is on the list. Anything you can do to help... contact the 'CYPs' (see website)
Thanks, Dr. Gilman, for yet another awesome video!
Dyane Harwood
MAOI Advocate
Author, "Birth of a New Brain-Healing from Postpartum Bipolar Disorder"
Thank you Dyane
I'm
So glad I found you Dr Gillman! I really want to go back on Nardil which is the one med that helped me the most. I regret getting off of it. The last two years I've been undergoing one med change after the next but nothing really seems to work. I'm afraid of the washout period that I will have to undergo before reinstating. 😰
These questions are answered in various places on the website and in the benchmark guidelines paper we have published - there is a link to the free download that paper on the homepage of the website and a few utilise that you might could contribute to the cost of publishing it was thousands of dollars
It's almost as if UA-cam is biased against high quality information... nevertheless your videos are excellent!
Thank you
Thanks for your work Dr. We spoke last week. I had only heard about this stuff last week. I have a good dr who was more than happy to prescribe Phenelzine Sulphate; luckily; he even commended me on being proactive (he is very aware of issues with drug companies/ PBS etc... But, it's true, I am a bit worried to find that i can only find 1 bottle of 60 15mg tablets in Sydney. A company is making them, but they are out of stock for a few weeks. It's a very worrying situaion for those who are on them.
Email or Skype me, I can probably help
Hello from Portugal ! First of all, love your videos, very informative and science based that i always look for. I am a 37 female recently diagnosed with adhd - innatentive. Since i remember myself i have always been kind of low mood / flat mood and with no much motivation to move (unless it was a novelty , then i would have high energy) , anyway, i have been looking and i dont think MAOI are used in my country. I am using Elvanse (Vyvanse) for almost a year now and even though i love it mood wise i dont think it has made me quite "there" yet . I am used to having this flat mood without many emotions going on , motivation is better, sleep is better but i wonder if serotonin is lacking. If so, how could i go about this ? What antidepressant could work well with something like Vyvanse (dopamine and noradrenaline) ? I am scared of the low libido side effects of most , my libido is null . Thank you if you happen to take the time :)
these video thumbnails are my life tbh
What should be expected when withdrawing from nardil after 28 yrs of use at 60 mgs.?
Is moclobemide (RIMA) better than SSRIs and SNRIs when traditional MAOIs are not available?
Want to know this to
Good evening, esteemed colleague Dr Gillman.
I am an Italian psychiatrist (Dr Nicola Mosti, from Pisa, Tuscany) and I have a couple of patients on Nardil therapy, the only drug among many that they have benefited from and through which they have been in remission for years.
Among those who suffer from treatment-resistant depression, however, I also have some patients who have not responded and/or who do not tolerate MAOIs. In these cases (atypical depression with prevalence of anergy, anhedonia and demotivation) I have had good results with pramipexole. However, I must confess that I am a little troubled by the prospect of having to use it on them for a long time. What do you think of this drug?
My best regards and the utmost respect for its valuable activity. 🙏
Hello Nicola please contact me via Skype or email or via website
Off topic, but I would like to hear your opinion on Tianeptine, I didn't find info in your webpage. As someone who has tried around 15 different antidepressants, I'm sick of being prescribed useless SSRI's that worsen my symptoms and no doctor is willing to pescribe me Tianeptine because (in their own words) "we don't know much about this paritcular med, never used in any patient". They have a similar attitude towards MAOIs, even when I show them papers, all they want to do is to stick to SSRIs, the newest ADs like vortioxetine and MAYBE some tricyclics at best. I feel betrayed by great part of the psychiatrist community, many of them don't seem to care enough about patient's wellbeing. What makes it more ludicrous is when they have no problems trying to give me high risk meds like clozapine, but they are so reticent about prescribing tianeptine.
Thanks for your videos, as always, very informative.
As you say, off topic. I simply don't have time to discuss every drug in the pharmacopoeia.
@@psychotropicalresearch5653 Do you understand the issue here ?
People who are prescribing rarely watch or hear or try to hear what you are saying.
And, patients keep suffering.
Demand is not based here on consumers, its on doctors, agencies .... Its far from possible for patients to get listened and push for demand.
Dont be in the dilemma of - Something is better than nothing. Its actually nothing as long as Doctors listen.
@@psychotropicalresearch5653 I was just asking for a brief opinion, not a dense discussion or article about it. Two senteces would suffice, or a citation to a source that summarizes your thoughts about it if you happen to have one. If this is a subject that you consider unable to be covered in the comment section of youtube, OK , I understand that. It is not my intention to waste your time.
@@bhaskartaneja6293 Bhaskar, I’m not sure how well people will understand what you are trying to convey here, nor indeed were ‘here’ is, but I conjecture you are in India? I write for a very international audience and I certainly apologise if I have insufficient knowledge of the considerable differences in the culture and medical systems in the countries of the various people who might read my work or listen to my videos. I sometimes think that people in America write and behave as if the rest of the world did not exist, and I certainly would not want anyone to think that sort of thing about what I do. If you have any ideas about how to increase awareness and usage of these drugs in your area them to do please communicate these to us, preferably to Heidi at PsychoTropical. You say ‘Dont be in the dilemma of - Something is better than nothing. Its actually nothing as long as Doctors listen.’ - perhaps you could explain about that a bit more? I may not be the only one who does not quite understand it. The response section is not really a venue for complex and abstruse peripheral considerations of issues in videos.
@@Megaghost_ perhaps what I should've communicated was that I do not have any experience of using that drug nor any depth of special knowledge about it so do not feel I'm qualified to offer any kind of expert opinion about it.
What are your thoughts about letting depression heal on its own living a healthy lifestyle ? If depression is stress induced why would it not be able to heal on its own considering stress reduction techniques ?
That question is too general, too broad, and too complicated, to even begin to address in a forum like this
@@psychotropicalresearch5653 I understand.
Because a lot of times biology is too powerful. And even if you can heal with alternatives, a lot of time there is not time. The person will inflict harm of committ suicide before any natural therapy works. What you are asking is like asking "Why don't we let someone with multiple bullet wounds heal naturally?" The answer is that the person will die from shock and blood loss much before any healing can happen.
Illness is illness is illness. If you had serious anemia of the blood you would not be asking such a question. depression is not “just a state of mind “, it can be an abnormality of brain function, like epilepsy.
@@quiksilver7373 Long before effective antidepressants people recovered spontaneously, so although what do you say can be true it is not always true.
Are antiparkinsonians like ropinirol pramipexole useful for depression?
Pramipexole is used for treatment resistant depression, yes.
There’s some research suggesting that Pramipexole is useful for TRD.
Likewise for Amantadine and Memantine.
Its impossible to get a doctor to prescribe Maoi's.
@@elazarziv8217 how do you fake a prescription? I'm sure you would be in all kinds of trouble if you got caught but at the same time I can understand how a person might be desperate enough to do that.
Elazar Ziv please do tell! Don't leave us hanging
Good day, Dr. Gillman. Thank you for such significant for science and patients information! I have dysthymia, fibromyalgia and hypoactive sexual desire disorder. I used to take milnacipran, it worked great for me, I become much more active and effective, pain go away, but my HSDD didn’t go away. I quit treatment with milnacipran 5 month ago and my depression coming back. Can IMAO be more effective for dysthymia, fibromyalgia and HSDD? Can I get longer remission with IMAO?
Yes, it is definitely an option to consider seriously
@@psychotropicalresearch5653 thank you very much for answer!
@@psychotropicalresearch5653 What about TCAs? Are they better than IMAOs in this case?
@@trynalive4373 the usefulness of the answer can only reflect the usefulness of the question! For some people yes, for others no! Read my review paper on TCAs.
Parnate 30mg stopped working after I’ve been taking it for 3 weeks. What do you recommend i do now?
These questions are answered in various places on the website and in the benchmark guidelines paper we have published - there is a link to the free download that paper on the homepage of the website and a few utilise that you might could contribute to the cost of publishing it was thousands of dollars
Hi Dr, if someone was in my shoes and had severe social anxiety, moderate generalized anxiety, and mild depression but couldn't be put on an MAOI would Sertraline be a good SSRI to try or is there something else you would recommend them?
Escitalopram is the most selective SSRI so that would be ideal to avoid serotonin syndrome
why couldnt you be put on an maoi?
@@ve_rb I very much doubt you have the knowledge or qualifications to give an opinion on such an important and complex matter
@@ve_rb It doesn't matter how selective a SSRI is; what matters is how potently it inhibits serotonin reuptake, and escitalopram is quite potent at it. Therefore, ES would absolutely, 100% cause serotonin syndrome if you take enough of it. You really shouldn't be giving advice to people. You can get them killed.
14:43 bupropion 16:16 sertraline and dopamine
I think you mean dopamine and sertraline
I imagine you are alluding to the fact that sertraline is a weak dopamine reuptake inhibitor, if you look on the website you will find information on this issue
@@psychotropicalresearch5653 Sorry I missed your comment. I put a timetamp to see it again. Is sertraline´s effect on dopamine strong enouh to have antidepressive effects?
Is there really a difference between Parnate and Tracydal in the Netherlands??
Probably not, or at least it would be very minor. Quality control and bioequivalence regulations are pretty tight. However, it does seem that phenelzine is the exception to this. The number of people reporting differences between the various preparations that have been available do seem to be significant.
@@psychotropicalresearch5653 Thank you very much for your anwer. I read some revieuws from people from the Netherlands who made the switch and felt different. But maybe its just those people who react online.
Im gonna start 1 september. Can parnate also help with adhd and cognitive functions?
Is Sertraline, i never tried it but i read you say its a good ssri? I react also pretty good to wellbutrin. So still thinking maybe wellbutrin and sertraline is a good option
What you think about pramipexole for depression?
you are perfect:)
I had akathisia and jerking in my limbs from Prozac and it really scared me from trying something after that. I was wondering if MAOI’s have a high incidence of akathisia?
No, v rare
Can i use Parnate with NAFLD grade 2?
yes
Do u think phenelzine is gone for good?
As with most comments on the UA-cam channel my responses is to go and look at the website which contains far more information -- but no, phenelzine is not gone, there is a special section about this on the website -- go look
Are MAOIs, specifically tranylcypromine, good for idiopathic hypersomnia?
No reliable data, but they work for narcolepsy
What about Abilify? Doesn’t that increase dopamine?
Sure seems to increase mine!
Yes Luke, it does have a modest dopamine boosting affect, but with a fairly low ceiling as far as the overall magnitude of the effect is concerned, otherwise it would make schizophrenia worse not better. Again, you'll have to wait for part two
PsychoTropical Research thanks for your reply doc. I also wanted to know would MAOI medications be useful for those who are addicted to dopaminergic drugs such as Adderall?
@@lukeraynor3704 No. *Nothing* elevates dopamine as much as cocaine and amphetamines. If that is your problem, a very slow taper is the best solution. but you can try rasagiline + tolcapone after withdrawal. But since tolcapone is very toxic to the liver, you will have to do that under a doctor's supervision. Your problem has nothing to do with depression. There used to be some slow-binding DRIs in the past like amineptine and nomifensine that could help you, but these drugs have been removed due to a few cases of abuse and addiction, so you will need to face withdrawal cold turkey.
Luke Raynor hey how have you been? Any better?
I got that its dopamine.. but isn't there a way to address why suddenly people start having low dopamine , essentially being depressed. Dopamine deficiency is the effect that has cascading effect with other symptoms - not the root or initial cause.
Or once corrected dopamine, body will get better , that's never the case. Hooked on MAOIS forever.
Also how one will tackle insomnia who has already got that with snris and ssris, considering Parnate and other MAOIs have substantial insmonia component.
Benzos and Antipsychotics cause memory loss... Their dependency has other severe effects.
Also thus the question arises on how to stop only on 1 or 2 drugs rather than making a cocktail of side effects for patients - keeping down one's side effects by adding another severe chemical.
What about Pramipexole?
Yes, study neuropharmacology for five years, then do a PhD, and then apply for a research grant to answer the question.
@@psychotropicalresearch5653 Did I hurt your doctor ego ?
Showing people that you studied much more , but cannot give an easy answer.
I have been a 1st hand subject for 10s of SSRIs, SNRIs, APs, Benzos and made to suffer. The withdrawals were hellish. Leaving them made me fatigued, stiff body, congestion, blurry eyes, feeling different from me, memory
The same answer were given by so called experts that I had gone to - "We are the experts. We studied. ". You are no different.
@@bhaskartaneja6293 You are acting like a complete jackass. Sometimes your body develops a deficiency of certain hormones and the only solution is to take hormone replacement therapy because there is no other way to make your body produce it. How would it be different to take something to help keep dopamine elevated if low dopamine is the cause of your depression..? Are diabetics "hooked on insulin" or what? You get dealt the cards you do in life, if you are given a chronic incurable disease then you have to make the best out of it. For people with diabetes it could mean using insulin for the rest of their lives. For some people with depression caused by low dopamine taking a MAOI, stimulant or dopamine agonist or whatever else for the rest of their life. You have to understand that depression/low dopamine can also exist as a chronic incurable disease just like type 1 diabetes where the only solution is management/"replacement therapy".
Why the fuck do you think low dopamine can't exist like a disease like low/no insulin, low/no thyroid hormones, low/no testosterone etc??
And just like Gillman says I can guarantee you that if you manage to find a solution to low dopamine that doesn't involve the use of drugs you could become a billionaire. :)
@@jacobski7216 You are 100% correct. A lot of people don't understand that genetics is the *primary* determinant of who you are. Genetics is not destiny, but it is close to destiny. Teh power of genes can be demonstrated by people that have congenital. hypercholesterol. Without cholesterol-lowering drugs like statins, they develop heart disease and die in their thrities and forties no matter what they do. Even if they eat nothing but green salads and exercise every day, their arteries still get clogged, and they die of myocardial infarction in their forties. Conversely, one of the genes found in super-centenarians is a gene that heps to make massive amounts of HDL, the "good" cholesterol. These people *never* develop heart disease, even if they are sedentary and eat pork fat every day of their life. Conversely, the poor sap that was born with shitty genes will eat steamed broccoli and run 10 miles a day, and still die from a heart attack. Life is not fair. life sucks. Fro instance, some people are born with a mutant version of the COMT gene that makes them exceedingly happy. They have at least 60% higher dopamine throughout their brain than regular people. They report over twice the positive emoptions of the average person. No matter how terribly life treates then, they still can't help but seeing the positive side of things.
On the other hand, some people with chronic depression and anhedonia just didn't luck out. for instance, some people are born with an "over-zealous" version of the dopamine transporter that cleans off dopamine from the synapsis much faster than usual. Others are born with the val-val version of the COMT gene, which breaks down dopamine very effectively. This leads to despondancy, pessimism, mental fogginess and despair. According to this guy, this person should just try to undergo therapy to address the "root" cause. but the root cause is biological. The person will feel like ST even after 20 years of therapy because talking can't overcome an invincible genetic program. Conversely, popping a pill that changes the way that the physiology of dopamine works works instantly. And we know that it works instantly, as anyone who has ever taken amphetamines or drugs that elevate dopamine a lot and very fast know.
A lot of damage is done in this World by people that believe that modern medicine is fraudulent and that we should return to a more "natural" life. This is know as "the naturalistic fallacy", where people think that Nature is better and that men screws up. But Nature did not design us to be super-happy or super0healthy, but rahter just to breed. Some people just get the worst genes. People can't accept this because they don't find it fair. but life is not fair.
@@petercoderch589Да но мы люди должны загнуть раком природу.)
What about
Could you please clarify and elaborate on that comment
@@psychotropicalresearch5653 sir by mentioning bupropion and sertraline do u say that we can try these if we don't want to take maoi and secondly i heard that withdrawal from maois is really very horrible n painful.
If dopamine is what missing why do stimulants in a lot of studies not improve depression when SSRI/SNRI are augmented with them. What is your experience augmenting with them ? Btw, great channel.
Good question but much too complex to attempt to answer here. Please feel free to Skype and if you can catch me when I have time I will try! Quick answer, it's probably a question of balance.
Stimulants are not effective at substantially increasing dopamine signaling evoked by brain activity... As the dose gets higher, it becomes less 'pulses' of dopamine and more a flood. But the low doses aren't strong enough. The high doses work at first (stimulant induced mood lift, what recreational users seek) but the brain compensates. Why? Because the brain interprets dopamine signals in relative ways, so if it sees a constant increase, it just resets its baseline. MAOIs are better because they can powerfully enhance dopamine pulses without flooding the brain.
Stimulants continue to work for ADHD because the prefrontal cortex doesn't care as much about the ups and downs of dopamine, as the reward areas do.
U r true sir seroquel is just a waste and stupidity
Taking a diamine oxidase (DAO) enzyme supplement with wine helped me with the malar rash. Prevents dietary histamine absorption.
Or drink cheaper wine, hahaha.
Alcohol is very bad thing
Your personal simplistic view about alcohol is not going to help anyone, and as Paracelsus said “What is there that is not poison? All things are poison and nothing is without poison. Solely the dose determines that a thing is not a poison,”
@@psychotropicalresearch5653 ok, its the your view, but no one as alcohol have ruined so many lifes and its my own experience and view.. So.. I can say more but my english is not enough good for that) peace, bro! Using selegeline is better even for the doctor!
In Italy there aren't IMAO irrevirsible. Where find? Foreign pharmacy is expensive?
Dopo l'uscita di produzione di Parmodalin, con cui ho condotto per anni la vita di una persona normale ho subito un crollo dal quale non riesco piú a uscire nonostante da allora mi continuino ad essere prescritti antidepressivi e altri psicofarmaci che risultano del tutto inefficaci. I farmaci acquistati all'estero mi sono stati ripetutamente bloccati in aeroporto e avviate procedure burocratiche che richiedono mesi perché il pacco di sblocchi. Alla fine ho dovuto rinunciare anche a quell'opportunitá. Impossibile immaginare una situazione piú assurda di questa.
There is Selegiline tho