“Sometimes depression isn’t resistant to treatment. Sometimes the wrong treatment is being given.” A neurologist said that to me when I told him depression meds had been useless for me. He prescribed Imipramine and eventually added Pramipexole and it was like some flipped a light switch and just turned off my depression. Bonus: the Imipramine also helps with my interstitial cystitis. I am very happy that a healthcare provider helped me, but it was frustrating that after 15 years of GPs and psychiatrists, it took a neurologist to really help.
Wow!! Thank you so much for sharing!! Maybe I’ll see my neurologist about my depression if Pristiq doesn’t work out, since I’ve had suboptimal improvement for THIRTY YEARS and nobody’s ever prescribed me a tricyclic. I’ve tried almost all if not all the SSRIs and SSNIs.
Same here. I wasted several years taking SSRIs (they were ineffective and had more side-effects than tricyclics). A smaller dose of Amitriptyline is better than a high dose for me.
@@DrTraceyMarks How important is it to remove psycho-social stressors when treating psychotic depression? Especially, when it comes treating psychotic depression in a nursing home environment? Can you please make a video on this? Thanks
Same for me! I had to tell my psychiatrist to stop prescribing me SSRIs, because I had severe reactions to all the ones they tried on me, over a span of ten years. Tricyclic antidepressants work so well for me!
Dear Dr. Marks, Thank you very much for this video. I'm so glad that you've brought up some of the essential advantages of Trycyclics. I'm not a medically trained professional (Retired Clinical Psychologist), but I can say that I have seen the Trycyclics in action from 1970 to 1980, and their effectiveness was spectacular, to say the least. I think the increase of ethical actions against practitioners (Some because of side effects) has probably led to doctors being careful to prescribe these. Also: I think the diagnostic category of Melancholic depression is perhaps based on Involutional Melancholia. The symptoms of I M are very unique and pathologically typical as described by Mayer--Gross et al. circa the 1960s. It's important not to forget or suppress these lessons from the past. I feel sad when I hear of patients continuing to suffer because of not being considered for some of the very effective Trycyclic antidepressants. Thanks again, Dr. Marks! Coert Mommsen D.Phil.(Psychology) M.A. Clinical Psychology, EEG Technician. South Africa
I took it in the early 90s and it worked great. I am currently taking Lexapro which works fine too, but I think I was over the noon with the tricyclic...Pamelor
Tricyclic and Tetracyclic antidepressants have been on the back of my mind a lot lately; mostly because i wanna go back on meds for my depression and anxiety, but had a *horrible* time when i was prescribed an SSRI and a Benzodiazepine the last time i was on medication. This video came out at a great time for me. Thank you so much for making it!
I had similar with SSRI’s. I’m currently on Wellbutrin and all I can say is that it saved my life . About ~ 9 weeks in, I wake up one day and just felt normal. I was so scared this was a fluke , but man, I’m back, my appetite is back, I’m no longer in deep depression, back in the gym, back to doing all the little things I used to love. ( I had a relapse in depression after losing my folks not long ago) god bless and good luck!!
@@LDiamondz I can suggest a heap of other great advice if you’d like. During my journey with meds that have both ruined my life and saved MY life I have become a pharmacology autodidact . The fact that we are on a thread discussing depression via drugs from the 50’s is sad alone!!! I live in NYC and unless willing to spend a ton of cash, good luck finding a good phych . Every place hires NPs now. Why? $$$$. Imagine going to a heart surgeon only to find out you’re being operated on by a nurse? Nice right??
@@theevilg3nius I know what you mean. I've been to so many doctors, I can't even name them all! 20+ years ago, I had (undiagnosed) Epstein Barre Virus, CFS, fibromyalgia. Nobody knew anything about them. Took me 10 years before one really great doctor diagnosed me. In those 10 years I developed Chronic MDD and anxiety. Mostly from pain, frustration, no dx, plus I was married to a narcissist! 🤯 Tried so many meds, since then. I don't think I ever tried Wellbutrin, though. Doctor hopping was exhausting, in itself. Nothing works for the MDD, so far. So, I'll try anything at this point. Maybe one of these old times meds would work. That'd be great. Sure, if you've got any info that could help, I'd be happy to hear it! Last few years, I just gave up trying. Only on meds for sleep disorders. Thanks for the reply! Your journey sounds a lot like mine, except yours is more recent, I hope. All the pain and exhaustion I was in. Doctors all told me "It's all in your head." It wasn't, they just couldn't figure it out. But, hey, now it IS all in my head, with the MDD. I'm in NJ, and mental healthcare is just as you described in NY. Doctor's only want to be specialists. They don't care about the 'whole' patient. Mental health is so far behind the times, compared to medical health. They should have been investing in trials for new meds and therapies, all along. They still go by teachings of Freud, and his ilk. Imagine if they did that with medical problems, too? They'd still be using leeches and morphine for headaches! It is pretty sad. Thanks. ❤
Educative as always. We in Africa have a lot of experience with Tricyclic Antidepressants (TCAs) being much cheaper and affordable than SSRIs and more readily available. And for severe depressive episodes TCAs have consistently proven to be effective. Anticholinergic side effects like dryness of the mouth, blurring of vision are common but thankfully patients develop tolerance to those within a few days to weeks. Urinary retention is commoner in people who already have urinary problems like elderly males with prostatic enlargement. By-and-large the tricyclics are very much effective and in use in Nigeria due to their availability, efficacy and affordability compared to other antidepressant classes. Lofepramine is said to be the only TCA that can be safe even in overdose but I have never prescribed it because it’s unavailable in Nigeria.
@@DrMukhtarYerima delighted to read your comment here . Yes, this is a wonderful resource. Wishing you and all your colleagues well in your practice of a part of health care that is dear to my heart personality and as a health care practitioner who worked in mental health across the life span. Also I note your comment on blessing. I think psychiatry and mental health and working with traumatised persons is well served when we endeavour to have a connection to a higher power, a spirituality that supports us to do our best for each person and see the importance of the essence of humanity in each person. I recently discovered a psychiatrist called Dr Gerald May. He passed away some years ago. He mostly worked as a prison psychiatrist, in the USA He has a deep faith that sustained him in his work and has written many books. Dr Richard Schwartz with Internal Family Systems. Who very generously also has lots of information on UA-cam has talked about this highest Self at the core of all humans no matter how much they suffer.
@@melliecrann-gaoth4789 Thank you so much for your kind response. I really appreciate it. I particularly like your wonderful perspective on mental health and spirituality. I will surely look up the works and contributions of Drs. Gerald May and Richard Schwartz, and i thank you so much for bringing that up and pointing me in their direction. We in mental health are indeed in a unique position since our methods and perspectives are usually bio-psycho-social which is an all-encompassing view of etiology as well as treatment of mental and behavioral disorders. Thanks so much once again and God bless you for all your works and contributions to the mental wellbeing of all the people that you have touched in one way or another.
Nigeria is in an idyllic league of its ow when it comes to psychiatry. Enugu doctors know the value of lithium and tricyclics. I can’t imagine why the west has chosen to forget about them in younger patients (it’s quite common to see people older than 40/45 on amitriptyline but soft antidepressants like citalopram are very-much over-prescribed).
Thank you for making this video. I wish I had this years ago, but I did at least educate myself some in the past to help advocate for myself. I experienced a lot of issues with SSRIs and SNRIs, which I later learned was because serotonin syndrome. One of the docs I saw early on completely disregarded me expressing concerns over the side effects I had from SSRIs and asking to try anything that wasn't an SSRI. I ended up stopping treatment completely for several years because of that doctor and also had an attempt after. The next doctor tried SNRIs but listened when I was sick from those and ended up putting me on a med that was new on the market at that time. The side effects on that had me off of them within 3 days. That was when we tried tricyclics. They have completely changed my life. Though, none of the doctors that have prescribed them ever mentioned the side effects. All of my doctors have known I have dysautonomia (orthostatic is a big issue in that) and said nothing. Luckily, I didn't see an increase in the orthostatic symptoms I already experienced prior, so we're all good there.
This was very informative. I'm going to save this video and keep notes for later particularly when consulting with psychiatrists and others regarding clients battling severe depression.
Nortriptyline was prescribed to me as I developed chronic migraines and also have some issues with back pain from slipped discs. It was supposed to be a better option than the related amitriptyline due to having a better side effect profile. While I did still have some side effects like dry mouth, vivid dreams, and constipation when first starting, it's not as bothersome and it helped to titrate up slowly. This is a really good video discussing the various uses of the tricyclics. Interesting to know they are still widely used for a variety of things today - they're one of the first line treatments to try for chronic migraine prevention
Yet another excellent video . In my experience , having tried at least 15 medications over the last 25 years , tricyclics also may be preferable for people who drink . Whenever I tapered down and stopped taking SSRI -SNRI 's I would stop drinking . When I started with another one , I would have strong alcohol cravings again . When I was on the tricyclics the cravings have been significantly less .
I have an extremely rare cranial nerve disorder called Glossopharyngeal Neuralgia (GPN). When AED’s failed to work, my neurologist and I settled on Clomipramine as the tricyclic antidepressant to try. It was chosen over others because I did have clinically diagnosed OCD at the time (and technically still do to this day). We noticed an immediate improvement in the pain GPN causes but it also caused some very strange side effects. Instead of obsessing over the things I normally did, I became immediately disinterested in everything, so much so that I developed medication induced depression. I also developed insomnia as well. I stayed on the medication for well over a year while my PCP tried to combat the depression angle without impacting the pain relief I was experiencing. The very first drug we tried was Duloxetine. I started at 30 mg and did notice slight improvement in my mood. Then when we tapered me to the 60 mg dose, I developed Serotonin Syndrome and could not move a muscle for two days because my entire body became rigid. Then we completed a gene test to determine what class of drugs was best for me. As it turned out, all of them except the tricyclic antidepressants were considered very dangerous for me to use. There was nothing in between as an option. After a little over a year, I could no longer handle the depression and insomnia and was weaned off the Clomipramine. We tried Lyrica for the GPN and it has since been working well. I recently began seeing a psychiatrist because my depression returned soon after I developed Fibromyalgia. This depression caused a shift to Excoriation Disorder alongside my OCD. We decided to try Amitriptyline with the permission of my neurologist to treat both the depression and GPN. Therapy has been helping with my OCD and excoriation symptoms. It’s been going much smoother than the Clomipramine ever did! Tricyclic antidepressants can work well, but you just have to find the right one!
Wowwww. This might actually be exactly what I need in my life. The Melancholic depression hit really hard with me and I definitely feel like I could use this. Thank you Dr. Tracy Marks🙏🏽
Another use for tricylics that's very much still relevant in their use in treating functional GI disorders. I developed functional dyspepsia after having my gallbladder removed. It's been an ENORMOUS struggle getting my psychiatrist to sign off on prescribing a TCA or co prescribing a low-dose one alongside an SSRI because, in his view, tricyclics are dinosaurs that have been replaced by the SSRIs and SNRIs. It's a pity that there isn't great cross-talk between the various medical specialties!
Just saying hello. :) I really appreciate the down-to-Earth manner in which you discuss what can be - to some - difficult topics. As someone who has dealt with mental health issues for much of my life, I took several psychology classes in highschool and early college because I wanted a way to find out what was "wrong" with me. However, it was not particularly fruitful because, as you have explained very diligently, we cannot diagnose ourselves. After seeking the help of a mental health professional, I have narrowed my scope of inquisition to the specific condition which I have been diagnosed. You have provided a great deal of insight and have given me the ability to ask my doctor the right questions to get the best treatment. Anywho, just saying hello, and also thank you.
My psychiatrist just suggested I add 5mg Trintellix to my 30mg Vyvanse. $350/month copay after $100 discount in the United States. It costs $33/month in the United Kingdom. I’m hesitant to pay that much.
How interesting i have also been prescribed Trintellix 20 mg first, plus Vyvanse 40 mg now, but Trintellix did not have any effect, & made me more suicidal. I have a dr's appointment tomorrow i want to change to Tolvon or Remeron (mirtazapin) or Zoloft (sertraline). Im wondering if SNRI is better due to my concentration & executing what needs to be done...? (ADHD). But my anxiety & procrastination is overwhelming getting shite done, & im all on my own. Good luck on your journey mate :)
Yes both of those meds are brand only so they are expensive. That's one of the big problems with prescribing the new medications if a person either doesn't have insurance or they have a high deductible plan.
@@DrTraceyMarks Yeah I’m stuck with Washington State’s top ACA/Obamacare plan. I MIGHT only owe the high copay up to a $2000 annual deductible. Their marketers figured that if they charge low premiums with a higher deductible, patients will be intimidated by sudden high billing and elect to get less care VS a predictable premium that adds up to the same.
That's interesting information. Throughout my battle with Major Depression and GAD I've been on 8 separate antidepressants. Out of all of those I would have to say, hands down, that Cymbalta or Duloxetine was the best at managing my depression. The main drawback for me and the reason my psychiatrist took me off was that I gained almost 100 pounds during my time with it. Being a relatively small-framed person this was beginning to cause issues in my joints especially my knees and ankles due to the excessive weight gain. I am currently on Trintellix 20 mg. which supposedly is the only FDA approved antidepressant NOT to cause weight gain but it still does somewhat, but not at much as the Cymbalta did. But the Trintellix doesn't do a lot for my depression, though. YMMV.
Thank you Dr. Tracey Marks! I am sure my best friend struggles with depression, especially since she has been dealing with her mother's alzheimer disease. Her therapist adviced her to see a psychiatrist, but she has traumatic experience with her mother's medication changes and sees herself potentially at the the same situation in the future. As a result she is really afraid of visiting a psychiatrist and I would like you to advice me on how I could maybe help her overcome that fear. Thank you again for everything! You are a treasure!
If she's already seeing a therapist, then the therapist must think med's may be helpful for her progress. It may be easier to see a primary care doctor and many of them will treat depression. I would talk about meds as a way to feel better faster and a complement to her therapy. If she doesn't want to take a med, then she'll need to keep up the work in her therapy for a while until she can process her fear about the future. If she doesn't see enough progress, she may change her mind about seeing a doctor.
I found your video after looking for info on amitriptyline for treatment-resistant(so far) chronic nerve pain. While I don't need this medication from a psychiatric perspective, your video was informative and of good quality. Thank you!
I'm from Brazil and doctors here still highly recommend tricyclics. at least in my experience, I've taken some of them treating myself for depression in the last ten years.
Loved the video! I'm a huge nerd on those topics, would you consider making a video on MAO inhibitors? 🥺 It would be really interesting to find out if they still get prescribed
Hello, I found worthwhile relief many years ago while taking Surmontil, a tricyclic. Not so on the more recent SSRI’s. Thanks for the great work you do Tracy.❤
What about orthostasis? Iam taking NT 10mg and this has been bothering me. I think I might just stop taking the medicine since I have health anxiety and this has been making me a lot more anxious 😅
I'm a guy who likes brass tacks, so I'd usually err on the side of naming compounds after structures, but when you have a drug class like TCAs which includes opioid agonists (tianeptine), dopamine releasers and reuptake inhibitors (amineptine), norepinephrine-dominant reuptake inhibitors (protriptyline), and serotonin-dominant reuptake inhibitors (imipramine), used to treat conditions as diverse as neuropathic pain, depression, migraine, narcolepsy, and ADHD, PERHAPS it's not as clinically relevant that they have three fused rings as it is that they have pretty varied and unique pharmacological profiles and effects.
wow, perfect timing for me! now it makes so much sense why I was prescribed SSRI for migraines at first. thank you for the video and I love the owls on your shirt ☺️
Look into upper neck instability/subluxation of the atlas if other treatment doesn’t help enough. Some good info on u-tube. It could be related to migraines…
@@BR-lq6bk thank you, I just read a bit about it and it is insightful! haven’t heard about micro-traumas that can be caused by prolonged sitting before, that could be my case (a desk job and nerdy hobbies). any tips what to do about it/how to get evaluated?
THANK YOU so much for your videos! After trying all different types of newer antidepressants for years I only found out that clomipramine worked perfectly for me by chance. I only wish I had this type of information that time!
Hey @@beckys6260, she takes only 10mg at night to help her sleep. For her, more isn't always better. It's so helpful she can't not take it, and has been taking it for maybe 20 something years in this small dose. AFAIK 10mg is a pretty small dose. If there's a reason it was prescribed for you, I think you should give it a go. I believe people can take up to 150mg per day, but then in those doses maybe the side effects are more problematic. Start at your 10mg, and pay attention to how you feel after several days. I suspect you don't need to be as concerned as if you were taking more. Best of luck and I hope it helps you!
@@jkeiffer one thing I’d chip in to that is that notriptyline has slight sedative effects so maybe that’s why more isn’t necessarily better for her. Have you talked to her about her taking it in the morning (or whenever she needs to be up and alert) instead?
Hi doc Tracy. The moot cause of stress, resentment, anxiety, rage, fear of trigger, and developing of defensive mechanism all lays in dealing with Narcissistic and Negative personality people .
I have back pain in my neck and lower back. I was on the opiate protical for a while. I also see a doc for depression. Doc put me lamatragine that helped with my mood swings, I get incredibly angry very easy. Last trip I asked the doc about Tramadol (one I've taken before that works GREAT for both) but it's a narcotic, venlafaxine, and amitryptiline. Gotta love the internet research, lol. She opted for amitryptiline. Took first pill, 25mg at dinner at a restaraunt. An hour later it wiped me out. EXTREME fatigue (covil level fatigue), blurry/double vision and I fell asleep at the restaraunt. Wife drove me home and I woke up 15 1/2 hours later. "hangover" all next day, more postictal in feeling. Still have hope, cut dosage to 1/4 pill trying to work up. If I can't, I'll try the other SSRI you recommended. Does one usually build a tollerance to side effects like some do to gabapentin?
I definitely agree amitriptyline works well as long as you take 2 hrs before actually going to sleep so you are not as groggy in morning. I was taking 50-75mg
I’ve tried almost everything including ECT, TMS and Ketamine infusions. Started acknowledging covert abuse and emotional neglect since childhood. This lead to finding an upper cervical specialist. Turns out I have a subluxation of my atlas (c1) probably stuck in misalignment for decades. Head injury, trauma, stress, posture, whiplash, abuse, repressed emotions can be a factor. It affects the vagus and cranial nerves. A regular chiro doesn’t do this type of adjustment. No cracking and popping but very precise shifts. A slow process but some get relief after just a few. Adhd meds helped some with depression, chronic fatigue, dissociation. Eventually was on too much and thought was getting better but started having flashbacks and maybe psychosis. Journal, meditation tapes or have someone you trust to talk to might help. Structurally if the brain isn’t getting proper blood/oxygen flow and fluid draining can cause all kinds of issues including anxiety, depression, cognitive function, migraines, gastrointestinal… Some good info on u-tube on upper neck instability/vagus nerve. Worth looking into. Also looking into Psyllicybin studies. Wish that was legal and available. So sorry so many are going through this. Keep searching and hoping we all get relief…
Sounds similar to what is happening to me. Tried many kinds of antidepressants, ketamine, nothing worked. Now I just started taking vyvanse and it's helping somewhat, but if it stops being effective I'll try mushrooms. Luckily I'm in Brazil and magic mushrooms are legal here
Ohmyfrickingod. I was switched to clomipramine from nortriptyline for BFRBs combined with balance issues to treat both conditions with one medicine. I was previously taking nortriptyline for balance issues. No wonder the clomipramine made my balance worse again and how validating that it actually wasn't in my head that I got dizzy again from the switch. Lovely summary!
@@blairsterling6141 okay but that is not related to my comment. I was born with a diagnosed balance disorder. It is not a side effect of my medication. It was diagnosed in infancy. I didn't have any psych meds in infancy. Not sure why you felt the need to comment that on my comment specifically when she said clomipramine can be bad for people with pre-existing balance issues.
@@blairsterling6141 also as an FYI. I was dizzy 22 hours a day before meds. Nortriptyline actually changed and saved my life. I eat healthy, drink lots of water, and I exercise. Contrary to popular belief, not all diseases are caused by meds. A lot of them are helped by them. With every medication, there is a cost-benefit analysis. That's an incredibly important analysis to make and review with a qualified professional and support network on your team who can help with the evaluation of weighing the options. That analysis is very personal and individualized to every case. Blanket statements are seldom the case for all people.
@@blairsterling6141 not my job but if you can imagine the room spinning 22 hours a day, how do you work, eat, get dressed, stand up, walk, shower, acquire water, finance medical visits, go to school, mentally feel, make any friends to support you, finance help to feed you and bring you water, finance a place to live, finance transit to get to medical visits or afford food or water, fill out paperwork to get that support, feel like your life is worth living, etc......
Thanks Dr Tracey, your videos are always helpful. Finally got the courage to write this, I'm living with bipolar 1 and I have been on medication for years, one of which was imipramine which helped with my bedwetting(onset was my teen years, my parents say from very young age I had never wet my bed) however it has been discontinued in south africa and now nothing(i.e Vesicare) works, I've even tried all types of therapy and urologists say there's nothing wrong with my system hence my psychiatrist put me on imipramine(found 200mg to be the perfect dose) because she suspected its more psychological, can you please do a video on this with other possible antidepressants that can help with this because I'm a 22 years old living with someone and it's depressing having to wakeup to a wet bed... thank you!
Your videos are remarkable and I love them! I'm been off antidepressants thankfully for 15 years because I don't need them anymore, but when the depression was there only Tricyclics would help. I would love to have you do a video on MAOIs. (I think that is what they are called). I know they are very dangerous antidepressants, but very effective if taken as prescribed with the right diet. Any thoughts? Thank you.
Dr. Marks, Thank you you very much for your many concise and helpful videos. I am wondering if you might discuss the MAOI medications, such as Parnate, in a near future video? Thank you!
Be aware that tricyclics can have different, but just as disruptive, effects on sleep. They also can trigger Mast Cell Activation Syndrome in the same ways that SSRIs can. That could increase your seemingly-allergic reactions and make you quite anxious. That could lead you to be given a benzodiazepine. And the game goes on....
So i'm bipolar and have been since 1989 after a very traumatic helicopter crash into the ocean triggering huge changes in my life, not diagnosed or treated until 2007. I have had 32 medication and dose changes since 2007 20 of them through our lovely pandemic. When i'm depressed they( the VA) always want to start SSRI, which after a couple days of taking it i have a complete violent breakdown., so we don't do that after the fifth time, even giving me benydryl with SSRI, nope. I think i felt more normal for the 17 years of struggle than the 15 years treated. I'm so sensitive to medications my psychiatrist literally said recently no more changes due to my side effect sensitivity. So i get to live life feeling outside my body, concentration getting worse and my very good memory going away. I tend to lean on the depressive side, the manic seems to be flattened by my drugs, stuck on Invega and Lithium and sometimes klonopin, Thank You for the Mandala coloring idea, it has really helped with sudden onset anxiety and i have been able to get back to building my 7 foot robot. I hope one of these days they make progress on bipolar, i'm 53yrs old hoping real fast.
Is my next step vyvase?? Survived childhood medical abuse prob cptsd....Diagnosis MMD. I am stabilized on Prestiq 50mg (Effexor) no changes 2 yrs. It raised my BP, which I have to get under control. Got rid of crippling pulses of adrenaline and anxiety throughout the day. Mild ASD, chronic depression, rumination, inattentive ADHD, sometimes slow slurred speech, no drive to do anything at all (not even watch TV, play video games). I feel like my brain will not wake up, do not breathe enough, zoned out and falling asleep..... Did blood vitamin tests, thyroid. Tried and failed w ssris.
The problem is people who are actively interested in trying tricyclics and MAOIs often know more about them than the doctors (who are trained to be more in favour of SSRIs than stronger antidepressants and have been for the best part of 30 years). The reason why SSRIs are more frequently prescribed these days over older antidepressants isn’t because they work better but because the side-effects are likely to be less severe and there’s less chance of successfully suiciding oneself on O.D. than with the more potent older drugs. Tricyclics (besides maybe amitriptyline) might not be first-line treatments anymore for those reasons but they actually are much, much, much more effective in testing these conditions than SSRIs (which can be next to useless for a lot of people) could ever be.
I was prescribed nortriptyline by a psychopharmacologist (had already tried 40+ meds at the time) at a time when I had been suicidal for over a month. Sadly it made me psychotic, it was scary. That was maybe 15 yrs ago. Still feeling the same these days, I’m treatment-resistant to everything. Psy recommended clomipramine a few months ago but due to my awful experience yrs ago I never tried it. ECT DBS or Vagus nerve implant is all I have left, I have low hope about those. Only ECT is insurance covered :( Really I wish I had access to psilocybin, I think it’d the one thing that would save me from near total dysfunction as of late. -Kind regards
And also want to say I am sorry no meds have worked so far and how much I admire you continuing to search for your right treatment ♡ I hope you find it and recieve many blessings!
I’ve tried almost everything including ECT, TMS and Ketamine infusions. Finally found an upper cervical specialist. Turns out I have a subluxation of my atlas (c1) probably stuck in misalignment a very long time. Head injury, trauma, stress, posture, stuffing emotions can be a factor. It affects the vagus and cranial nerves. A regular chiro doesn’t do this type of adjustment. No cracking and popping but very precise shifts. A slow process but some get relief after just a few. Adhd meds helped some but was on too much and didn’t realize what was going on. Worth looking into if structurally the brain isn’t getting proper blood/oxygen flow and fluid draining. Some good info on u-tube on upper neck instability/vagus nerve. Also looking into Psyllicybin studies. So sorry so many are going through this. Keep searching and hoping we all get relief…
They grow out of the ground. Use the internet to find out about growing and you never know. Some may pop up near you😉. The spore prints are not hard to get and legal depending on where you live. Great hobby, it's saved my life and I find growing them has been a big part of my recovery. Stay strong, mush love.
I have severe OCD and also depression. I’ve tried SSRIs and SNRIs but the ONLY med that worked and saved my life was Clomipramine (Anafranil) I take 50 mg and it made wonders for me. It reduced my OCD symptoms and my depression disappeared. I am not saying that it works for everybody, but there is definitely room for these type of meds in nowadays too.
It’s often a case of getting what you bargain for, in an allied principle-vein to higher-quality products being more expensive. Tricyclics may come with worse side-effects with SSRIs but not without reason. Sometimes a person just has to tolerate severer side-effects in favour of better symptom-relief and decide for themselves if it’s worth it. Clomipramine’s a wonder-drug for many. I’m glad it’s worked for you.
If I'm not mistaken, in a large meta-analysis, amitriptyline was found to be the most effective antidepressant- outbeating all the SSRIs in symptom relief. Escitalopram (mostly) seems to be okay for me. But I find the TCAs interesting: in being less selective it seems they're both more effective while also more loaded with side effects by targeting unwanted receptors like histamine and the municinergic system (may have butchered some of that - just a guy with depression who's tried to learn too much about all this!)
Not sure where your depression falls on the scale but you may know more than most physicians that treat us. Sad it is 2022 & we are still experimenting. Yes? Maybe I'm just not realizing we are still in infancy.
There are all sorts of positives to tricyclics (and MAOIs but the likes of phenelzine are extremely difficult to take so I wouldn’t recommend that as even a third choice for most people). That’s why I find it funny when all these people like Joe Rogan and baby-wave doctors who don’t know about tricyclics who make no hesitation in pointing out that SSRIs might not be as effective because ‘depression isn’t necessarily a direct cause of serotonin imbalance yo.’ We know. That’s why tricyclics and other antidepressants of that ilk came before them in the first place. The effectiveness of SSRIs can’t be denied but many, many people benefit from the more traditional, potent agents.
@@Anonymous_Anon882The classic MAO inhibitors get a bad wrap. Phenelzine is generally harder to tolerate than Tranylcypromine, but as long as you can stick to a diet that isn't nearly as restrictive as people think, most people can tolerate it well.
@@vwvqr that’s the one. I may have said this elsewhere but taking a compatible tricyclic antidepressant with an MAOI (in other words anything besides imipramine and more especially clomipramine) can totally avert what tyramine-hypertensive risk exists. So if someone’s taking nortriptyline, trimipramine, amitriptyline or doxepin (for example) with phenelzine or tranylcypromine they might not need to worry about what few genuine dietary restrictions exist at all. I wouldn’t be scared of taking phenelzine if I needed it. Side-effects can potentially be rough with any medication but I’m the sort of person who’d air more on the side of phenelzine than tranylcypromine. Bupropion and desipramime (and I guess nortriptyline) are there for people who need a stimulating antidepressant. I think Parnate’s just a more intense version of that. The amphetamine thing can worry people who like to avoid anything vaguely reminiscent of speedball-highs or the stuff that Walter White’s been known to cook up. I feel like in that sense it’s really a class B drug (which I’m not saying is a bad thing, just off-putting for people who don’t really like anything stimulant). Getting through a can of Red Bull can be heavy enough for some people.
@@Anonymous_Anon882 The pharmacology is too complex for me to comment, but quoting Ken Gillman, taking Nortriptyline and Tranylcypromine makes Tranylcypromine safer. I believe it was in reference to some prescribers refusal to prescribe any TCA and MAOI together due to imagined risk of serotonin syndrome (aside from with those you mentioned). As someone on Nortriptyline, Tranylcypromine and Lithium though, I still mind what I eat and don't really test it too much, but I have never had a particularly noticeable tyramine reaction.
Hai madam. Thank you very much for your contribution to the mental health. I'm a dentist from India and i love your videos very much. Please make your book available in India. I'm also very curious to know what you are providing as bonus for pre-ordering of your book. Kindly share your PayPal account details so that I can pay you directly and get your ebook through email. Finally thank you very much. You deserve lots of appreciation and recognition worldwide. 🙏🙏🙏
150mg of Venlafaxine augmented with 20mg of Amitriptyline per day has been working better for me (history of substance abuse, depression, social anxiety) than countless other combinations of antidepressants and neuroleptics. Tricyclics are a godsend and don't have any noticable side effects for me (probably due to the low dosage).
SSRIs never did anything for me but make me angry and fat. Just started a TCA for my OCD and my life feels changed. Its always worth trying something if your doctor is on board as well :) i was scared to try but glad I did.
I was put on amitriptyline 20 years ago for chronic muscular pain. A few years later I was switched to nortriptyline because the side effects (especially dry mouth) were less severe. On balance I think it has worked for me (I've spent periods at different doses and periods off of it)
Thanks for noticing Sia. I moved some things around in my studio and I think the light is a little further back. I've also been using white light on the background instead of color.
My doctor change my meds from fluoxetin to bupropion because fluoxetin caused me anorgasmia. Would you please talk about libido issues and anorgasmia?. I feel like sexual life is important for people who has depression and not many doctors seems to notice. Also because I thought anorgasmia wasn't a big deal compared to improve in other areas, but I just mentioned to my doctor and then she changed my meds and helped me a lot. Thanks again Dr for your videos ☺️
Thanks for the suggestion Gaby. I'll add it to my list. Yes, anorgasmia can be a big problem with the SSRI's, but not with Wellbutrin. I'm glad that switch is working for you.
I have had the same problem when on SSRIs and SNRIs, since switching to Clomipramine is has majorly helped in this area but not entirely fixed it either. A friend of mine stopped with their meds completely as they had made him impotent and so therefore miserable and putting a strain on his relationship. So yeah I am totally keen for a vid on this problematic side effect too
I too, had sexual disfunction on prozac. ED, or antiorgasm. Every antidepressants I have tried ruined my sex life. Lack of sexual satisfaction led me into deeper depression.
Just a suggestion: your psychiatrist can prescribe cyproheptadine to combat this sexual side effect, take it about an hour before sex and it eliminates the anorgasmia.
@@yvonnebarash9373 ..thank you ! Men and women need orgasms almost daily. It is nature at work. It is a miracle and beyond wonderful. Women and men deserve maximum pleasure.
Warning ⚠️ to anyone to takes a tricyclic: taper if you stop taking your medicine. If you stop abruptly, then you will fall into the PITS Of DESPAIR 😭😭🥴🥴. My neurologist prescribed me a small dose of amitriptyline as a migraine preventative. I didn’t see any improvement in migraines. I started having these itchy, pins and needles sensations all over my back when I took this medication. My doctor didn’t advice me to taper when I told him I wanted to stop this medicine. Ugh ☹️
Wow. Not only are you a very interesting and knowledgeable but you’re spot on. I have severe OCD manifesting itself in hypochondriasis or psychosomatic disorder. I started taking Anafranil in 1992 right after it was approved in the United States and it is the ONLY drug that kept a severe case in check. I was taking anywhere from 50mg to the maximum dosage of 250 mg. It gave me my life back. So much so that when I was diagnosed with Renal Carcinoma I just said ok, how do we treat it and wasn’t upset at all. Unfortunately a year ago I had to stop taking Clomipramine (Anafranil) because I have benign prostatic hyperplasia and Anafranil or Clomipramine is an anticholinergic drug and is a no no for BPH so I’m stuck taking prozac and my hypochondriasis is out of control and I’m getting physical symptoms that are manifesting themselves on my skin and in other ways. I am so desperate that I’m willing to go to my urologist to have my prostate removed just so I can take Anafranil. Again I have listened to many psychiatrists and you seem to really be compassionate and incredibly well informed. Thank you.
Oh my, Lazer! First off, that's amazing that Anafranil worked so well for you for almost 30 years. Congratulations for being a cancer survivor. I hate that you still got one of the few conditions that make you not be able to take the medication and that prozac failed you. I can see how you would want to consult with your urologist - it's not easy for people to relate to how debilitating OCD symptoms can be. If your urologist doesn't think it's a good idea, you may want to look into Transcranial magnetic stimulation for OCD. I haven't treatment someone who's gotten it, but I think it's better than the SSRI's.
@@lazerlazer It's a little different from ECT. I talk about both in this video ua-cam.com/video/O09eRuYbqPU/v-deo.html I don't know if I mention TMS for OCD in this video because that protocol is new. TMS started out being used for depression only.
I bought a tricycle but pedaling is really hard. On the plus side, I'm a deeply bitter and cynical old man, so seeing people suffer cures my depression. Even if it's me suffering, while trying to ride a tricycle. "This SUCKS. Bwah ha ha ha!" So yeah. Tricyclic antidepressants worked for me.
After trying a quite few ssri’s and not getting on with them I was put on the tetracyclic mirtazapine. For me they were perfect, no noticeable side effects and they help me sleep and eat.
I’m taking doxepin rn for anxiety/depression, It’s a tricyclic antidepressant. It’s weird that they aren’t used often because of their side affects but I’ve actually had FEWER side affects from this than from “newer” antidepressants
Which is exactly why it’s often better to make an informed decision on the knowledge that you can scale down/switch if the side-effects become more than you can feasibly tolerate than let your doctor put you on the lowest possible dose of a softer drug because of “side-effects.” Your tolerability bandwidth is yours and something only you’re going to fully know.
The SSRIs weren’t doing it for me. It seemed like they gave me bad headaches, but my main problem was that it took away my happiness and my sadness. I had no highs or lows at all. Just emptiness. I take Remeron (mirtazapine) now and that does it for me. I think it’s considered a NaSSA and it’s an antihistamine too. Usually when I try to go to sleep at night my thoughts are going like crazy, but the Remeron helps put me to sleep. I’m also underweight and the Remeron makes me hungry, so that’s another good thing it does. The only thing with Remeron is you have to plan to take it at least 12 hours before you plan to wake up (basically take it at 8:00pm if you plan to wake up at 8:00am) otherwise you will feel and be like a zombie for a couple of hours after you wake up. I also take Buspar (buspirone) for GAD and OCD (my obsessive issues are worse than my compulsive issues) but I haven’t been taking it long enough to see/notice anything. I like that it’s a non addictive way to treat anxiety disorders though. The Remeron also doesn’t “fix” my depression. It helps, but I am currently in a major depressive episode and I still have really bad days. Living with major depression is a lot like living with a disease in the sense that some days I have flare ups where it’s really bad and other days where it’s still not good but a little more manageable. It is just such an exhausting thing to constantly go in and out of episodes over the years and wonder if it’s ever going to end. I try to be hopeful but it’s hard and it’s especially hard to go through college when I’m so ill like this.
I was on sertraline for a while and switched off them due to upsetting, severe, emotional dulling. What's the point of treatment if it takes all your joy away too? Just zombie shuffling through life sux
What is your dosage? I was on 45 mg and had no problems over the day with tiredness. Now i am on 30 mg and am tired and getting out of bed is harder. My sleep is better though. I dont want to go back and think about going lower again.
Oh boy if only people knew what they were getting into. Correction we need more evidence on its benefits vs risk, we barely have any on SSRi/SNRI, Antidepressants. We currently have no evidence beyond 6 months. You are talking about recommendations for meds and procedures known to disable the brain to treat a mostly made up diagnoses which have zero medical or scientific interventions in... Go ahead, next time you speak with you're psychiatrist ask them how the DSM manual (We are currently uo to DSM-5) was created... It's puesdoscience, every diagnoses in that book was voted in, no tests, no studies no scientific evidence anywhere for their existence which is why psychiatry is the only field where you can go to 5 different psychiatrist and walk out for 5 different diagnosis. It blames my mind how willing people are to do note their minds and bodies without evidence. The only pieces of evidence avaiare observational reports and opinion pieces along with some anecdotal reports which are all useless in medical Stastical overviews. But what's more concerning is that many of the permanent symptoms can take years to pop up. Once you undergo this form of treatment the clock starts ticking, many end up with the inability to talk properly and or bedridden for decades due to these drugs. Again they work by disabling the brain. That's something you want to cheer on? Zero evidence? Good luck with your treatment.
I have spent a little time trying to understand my depression medications. Which ones work and which ones I can not tolerate. This lesson here by Dr. Tracy has cemented my knowledge and assumptions. SSRI and SNRI all make me feel like I am , for want of a better word, on dirty meth. Feelings are dire. The cyclics work wonders for me. I have 15mg Mirtazapine + 50mg Amitriptyline at night. Mornings 15mg Mirtazapine and I am back to normal. SSRI and SNRI send me crazy giving me, only, the motivation to plan my funeral.(paradox) . Why?
Thank you for another very well explained topic. What is your take on sulpiride as antidepressant? I was prescribed sulpiride for irritable bowel syndrome but I noticed that my depression got better with it. However at 200mg dosage it gave me itches so I was forced to reduce back to 100mg a day. Can I keep on taking it long term?
I wanted to put in a request. I’ve been watching your videos for a while now and they’ve been helping me a lot! Could you do a video on bipolar and Seroquel? So many people like myself get put on Seroquel during a big episode and end up taking it ongoing, which then leads to brain problems. It got so bad that I couldn’t learn anything new, or remember what time it was. I’m now tapering down but I feel lost as to what kind of medication is best for a bipolar who isn’t currently in a major episode. The only thing currently holding me to medication is my inability to sleep. I just feel like bipolar and medication is much more complicated than one would think. I would love to hear your input on this topic. Bipolar is very prevalent in the state of WA.
Seroquel created your brain problems... most antipsychotics CAUSE brain malfunctions. CAUSE! ... psychiatry will never admit this...read Dr. Peter Breggin please.
TCAs are not usually prescribed here in Australia due to high toxicity related deaths in case of an overdose. Every time I’m admitted to hospital they end up having to order them from pharmacy - which is about a 12 hour wait - because they don’t carry them in psych wards. It’s really unhelpful for anxiety or for severely suicidal patients like myself. I was put me on them as a last ditch effort to help with my treatment-resistant depression. It didn’t do diddly, and I’m experiencing worsening dark thoughts & poor sleep quality (it’s taken at night).
I'm on amitriptyline and mirtazapine for three weeks now and I think this combination works well for me. I tried SSRI's in the past, either didn't work (ladose) or had a lot of side effects (zoloft , seroxat). Definitely worth trying something different.
SSRIs have always been comparatively weak antidepressants compared to the real nuclear bullets (tricyclics, MAOIs, venlafaxine, possibly etc.). Amitriptyline’s always worth a go if side-effects can be mitigated or tolerated.
HELLO DR. TRACY. I WOULD APPRECIATE IT IF YOU COULD CREATE A SHORT SCENE OF SOMEONE WITH A MENTAL PROBLEM AND WHAT THE PERSON MUST DO IMMEDIATELY. I THINK PEOPLE WILL RELATE MORE TO IT AND APPRECIATE SOLUTIONS
Hi Healthy life. Thanks for the suggestion, but I wouldn't know where to start with that. I give examples here and there in my videos and the examples fit the topic. I work better starting with a topic rather than starting with a random behavior and trying to deconstruct. But there may be some mental health channels that do that.
I’m on this now because my doctor suspects the SSRI fluvoxamine I was on was causing me a low WBC. It’s working ok so far, but I’m only on 25 mg a day before bed. Anxiety is mostly gone and sleep has improved, but focus hasn’t fully returned. It’s only been a few weeks, so maybe I need some more time with it before deciding to increase my dose. I had been off of fluvoxamine for 4 weeks before deciding to go on this instead.
Hello. To be honest, I don't know who I can turn to. Maybe you can tell me something. I am 19 years old. Two months ago I was prescribed carbomazepine and sonopax (anxiety, depression, intrusive thoughts). The dosage was low. These medications were helping me. But then a traumatic event occurred and the medications became less effective. The doctor decided to prescribe clofranil 25 mg 3 times a day. On the second day of taking it, after sleeping: I got out of bed and just fell over, because I couldn't feel my legs, I had a burning sensation in my head, a terribly fast heartbeat and sweating. My mother and I called the attending physician and she cancelled all the medications. The first three days the condition was just awful, it was like everything was changing in my head. My blood pressure was jumping from 85 over 50 to 150 over 100. Now it's been 14 days since I've taken anything. The burning has gone, but what remains is a strange condition: impaired tactile sensations, sleep disturbance, a strange feeling in my head, a feeling of weakness in my limbs and their remoteness (as if I do not feel them periodically or feel them remotely), drowsiness, etc. Before taking clofranil my condition was very good: I went to the gym, studied, did voluntary work. I can't understand what could have happened in my head that now I have this condition. And I don't know if it will go away or not. Can you please tell me what it could be? Is there any way to fix what has been disturbed in my head?
Dr., I have complex PTSD and Generalized Anxiety. How can I stop waiting for the other shoe to fall? I have no thoughts of worry. It's just a constant feeling. I don't need a reply. Just a video or link would be good.
I take 45mg mirtazapine. I have cptsd, psychotic depression with psychosis, strongest dose but it's a tetracyclic antidepressant. They tried sertraline and it didn't work, within days I had a major reaction that wasn't even listed on the side affects.
Actually 🤓 @33:00 When I was in the 18-24yr range, I got thoughts of suicide that were never there before or after I was on that specific ssri and I was not made aware of that black box warning until years after that event. So I think it's fair to say there is more correlation than is hypothesized here
THANK YOU!!! I take clomipramine (I also take anti-psychotics too) and my psychiatrist monitors my BP and other stuff but more and more I have been getting severe, debilitating, painful edema and another side-effect you described, but I had no idea my meds could be the cause. I have been having tests done by my GP but I should take that up with my psychiatrist asap! Although that really sux as I have been on and off just about every medication and Clompramine is the only thing that helps me gain control over my severe OCD (official diagnosis) and self harm. Cut me a break universe...damn!! Do you think it's worth me discussing switching to those next gen options you mentioned towards the end of the vid? Do you know if they could be just as effective in treating severe OCD?
@@aryan991000 I was having more memory issues before the switch to clompramine. But mine were due to some kind of dissociation or fugue directly linked to my anxiety. These meds have helped me gain clarity and control in a lot of areas, but not fixed it entirely, I still gotta work at it with CBT and ERP. But everyone is different so I would still talk about memory issues with your psych. Also, you mentioned that you are on 25mg pd. I am on 175mg pd, plus 150mg Quetiapine so it's possible we have very different experiences. But memory issues are an important red flag so you should tall to your doctor about it
“Sometimes depression isn’t resistant to treatment. Sometimes the wrong treatment is being given.” A neurologist said that to me when I told him depression meds had been useless for me. He prescribed Imipramine and eventually added Pramipexole and it was like some flipped a light switch and just turned off my depression. Bonus: the Imipramine also helps with my interstitial cystitis. I am very happy that a healthcare provider helped me, but it was frustrating that after 15 years of GPs and psychiatrists, it took a neurologist to really help.
Pramipexole for parkinson?
Why type of depression do you have
Wow!! Thank you so much for sharing!! Maybe I’ll see my neurologist about my depression if Pristiq doesn’t work out, since I’ve had suboptimal improvement for THIRTY YEARS and nobody’s ever prescribed me a tricyclic. I’ve tried almost all if not all the SSRIs and SSNIs.
Why he added Pramipexole ?
Her voice clarity and content, is amazing!
Im on a tricyclic antidepressant (I have severe reactions to ssri's and snri's) and it's been a lifesaver for me.
Same here. I wasted several years taking SSRIs (they were ineffective and had more side-effects than tricyclics). A smaller dose of Amitriptyline is better than a high dose for me.
Oh that's great they have been so effective. I have to keep reminding myself not to forget about them.
@@DrTraceyMarks How important is it to remove psycho-social stressors when treating psychotic depression? Especially, when it comes treating psychotic depression in a nursing home environment? Can you please make a video on this? Thanks
Wow really? May I ask the name?
Same for me! I had to tell my psychiatrist to stop prescribing me SSRIs, because I had severe reactions to all the ones they tried on me, over a span of ten years. Tricyclic antidepressants work so well for me!
Dear Dr. Marks, Thank you very much for this video. I'm so glad that you've brought up some of the essential advantages of Trycyclics. I'm not a medically trained professional (Retired Clinical Psychologist), but I can say that I have seen the Trycyclics in action from 1970 to 1980, and their effectiveness was spectacular, to say the least. I think the increase of ethical actions against practitioners (Some because of side effects) has probably led to doctors being careful to prescribe these. Also: I think the diagnostic category of Melancholic depression is perhaps based on Involutional Melancholia. The symptoms of I M are very unique and pathologically typical as described by Mayer--Gross et al. circa the 1960s.
It's important not to forget or suppress these lessons from the past. I feel sad when I hear of patients continuing to suffer because of not being considered for some of the very effective Trycyclic antidepressants. Thanks again, Dr. Marks! Coert Mommsen D.Phil.(Psychology) M.A. Clinical Psychology, EEG Technician. South Africa
Love your videos! They have helped me understand my condition and other issues so much better, thank you! 💗
I'm so glad Samantha, that's exactly why I make them. 😊❤️
@@DrTraceyMarks Is untreated psychotic depression considered a medical emergency?
I took it in the early 90s and it worked great. I am currently taking Lexapro which works fine too, but I think I was over the noon with the tricyclic...Pamelor
Tricyclic and Tetracyclic antidepressants have been on the back of my mind a lot lately; mostly because i wanna go back on meds for my depression and anxiety, but had a *horrible* time when i was prescribed an SSRI and a Benzodiazepine the last time i was on medication. This video came out at a great time for me. Thank you so much for making it!
I had similar with SSRI’s. I’m currently on Wellbutrin and all I can say is that it saved my life . About ~ 9 weeks in, I wake up one day and just felt normal. I was so scared this was a fluke , but man, I’m back, my appetite is back, I’m no longer in deep depression, back in the gym, back to doing all the little things I used to love. ( I had a relapse in depression after losing my folks not long ago) god bless and good luck!!
@@theevilg3nius That's a wonderfully encouraging statement! I'm going to look into it. I'm glad to hear it worked for you. ❤
@@LDiamondz I can suggest a heap of other great advice if you’d like. During my journey with meds that have both ruined my life and saved
MY life I have become a pharmacology autodidact . The fact that we are on a thread discussing depression via drugs from the 50’s is sad alone!!! I live in NYC and unless willing to spend a ton of cash, good luck finding a good phych . Every place hires NPs now. Why? $$$$.
Imagine going to a heart surgeon only to find out you’re being operated on by a nurse? Nice right??
@@theevilg3nius I know what you mean. I've been to so many doctors, I can't even name them all! 20+ years ago, I had (undiagnosed) Epstein Barre Virus, CFS, fibromyalgia. Nobody knew anything about them. Took me 10 years before one really great doctor diagnosed me. In those 10 years I developed Chronic MDD and anxiety. Mostly from pain, frustration, no dx, plus I was married to a narcissist! 🤯 Tried so many meds, since then. I don't think I ever tried Wellbutrin, though. Doctor hopping was exhausting, in itself. Nothing works for the MDD, so far. So, I'll try anything at this point. Maybe one of these old times meds would work. That'd be great. Sure, if you've got any info that could help, I'd be happy to hear it! Last few years, I just gave up trying. Only on meds for sleep disorders. Thanks for the reply! Your journey sounds a lot like mine, except yours is more recent, I hope. All the pain and exhaustion I was in. Doctors all told me "It's all in your head." It wasn't, they just couldn't figure it out. But, hey, now it IS all in my head, with the MDD. I'm in NJ, and mental healthcare is just as you described in NY. Doctor's only want to be specialists. They don't care about the 'whole' patient. Mental health is so far behind the times, compared to medical health. They should have been investing in trials for new meds and therapies, all along. They still go by teachings of Freud, and his ilk. Imagine if they did that with medical problems, too? They'd still be using leeches and morphine for headaches! It is pretty sad. Thanks. ❤
Educative as always. We in Africa have a lot of experience with Tricyclic Antidepressants (TCAs) being much cheaper and affordable than SSRIs and more readily available. And for severe depressive episodes TCAs have consistently proven to be effective. Anticholinergic side effects like dryness of the mouth, blurring of vision are common but thankfully patients develop tolerance to those within a few days to weeks. Urinary retention is commoner in people who already have urinary problems like elderly males with prostatic enlargement. By-and-large the tricyclics are very much effective and in use in Nigeria due to their availability, efficacy and affordability compared to other antidepressant classes. Lofepramine is said to be the only TCA that can be safe even in overdose but I have never prescribed it because it’s unavailable in Nigeria.
Aah thanks for this Dr. Yerima. It's good to hear your experience. 👍🏽
Thanks so much ma’am. You are such a huge inspiration to me. Remain blessed ma.
@@DrMukhtarYerima delighted to read your comment here . Yes, this is a wonderful resource. Wishing you and all your colleagues well in your practice of a part of health care that is dear to my heart personality and as a health care practitioner who worked in mental health across the life span. Also I note your comment on blessing. I think psychiatry and mental health and working with traumatised persons is well served when we endeavour to have a connection to a higher power, a spirituality that supports us to do our best for each person and see the importance of the essence of humanity in each person. I recently discovered a psychiatrist called Dr Gerald May. He passed away some years ago. He mostly worked as a prison psychiatrist, in the USA He has a deep faith that sustained him in his work and has written many books. Dr Richard Schwartz with Internal Family Systems. Who very generously also has lots of information on UA-cam has talked about this highest Self at the core of all humans no matter how much they suffer.
@@melliecrann-gaoth4789 Thank you so much for your kind response. I really appreciate it. I particularly like your wonderful perspective on mental health and spirituality. I will surely look up the works and contributions of Drs. Gerald May and Richard Schwartz, and i thank you so much for bringing that up and pointing me in their direction. We in mental health are indeed in a unique position since our methods and perspectives are usually bio-psycho-social which is an all-encompassing view of etiology as well as treatment of mental and behavioral disorders. Thanks so much once again and God bless you for all your works and contributions to the mental wellbeing of all the people that you have touched in one way or another.
Nigeria is in an idyllic league of its ow when it comes to psychiatry. Enugu doctors know the value of lithium and tricyclics. I can’t imagine why the west has chosen to forget about them in younger patients (it’s quite common to see people older than 40/45 on amitriptyline but soft antidepressants like citalopram are very-much over-prescribed).
Thank you for making this video. I wish I had this years ago, but I did at least educate myself some in the past to help advocate for myself. I experienced a lot of issues with SSRIs and SNRIs, which I later learned was because serotonin syndrome. One of the docs I saw early on completely disregarded me expressing concerns over the side effects I had from SSRIs and asking to try anything that wasn't an SSRI. I ended up stopping treatment completely for several years because of that doctor and also had an attempt after. The next doctor tried SNRIs but listened when I was sick from those and ended up putting me on a med that was new on the market at that time. The side effects on that had me off of them within 3 days. That was when we tried tricyclics. They have completely changed my life. Though, none of the doctors that have prescribed them ever mentioned the side effects. All of my doctors have known I have dysautonomia (orthostatic is a big issue in that) and said nothing. Luckily, I didn't see an increase in the orthostatic symptoms I already experienced prior, so we're all good there.
Hi. Which med you have been using ?
This was very informative. I'm going to save this video and keep notes for later particularly when consulting with psychiatrists and others regarding clients battling severe depression.
Nortriptyline was prescribed to me as I developed chronic migraines and also have some issues with back pain from slipped discs. It was supposed to be a better option than the related amitriptyline due to having a better side effect profile. While I did still have some side effects like dry mouth, vivid dreams, and constipation when first starting, it's not as bothersome and it helped to titrate up slowly. This is a really good video discussing the various uses of the tricyclics. Interesting to know they are still widely used for a variety of things today - they're one of the first line treatments to try for chronic migraine prevention
Yet another excellent video . In my experience , having tried at least 15 medications over the last 25 years , tricyclics also may be preferable for people who drink . Whenever I tapered down and stopped taking SSRI -SNRI 's I would stop drinking . When I started with another one , I would have strong alcohol cravings again . When I was on the tricyclics the cravings have been significantly less .
I have an extremely rare cranial nerve disorder called Glossopharyngeal Neuralgia (GPN). When AED’s failed to work, my neurologist and I settled on Clomipramine as the tricyclic antidepressant to try. It was chosen over others because I did have clinically diagnosed OCD at the time (and technically still do to this day). We noticed an immediate improvement in the pain GPN causes but it also caused some very strange side effects. Instead of obsessing over the things I normally did, I became immediately disinterested in everything, so much so that I developed medication induced depression. I also developed insomnia as well. I stayed on the medication for well over a year while my PCP tried to combat the depression angle without impacting the pain relief I was experiencing. The very first drug we tried was Duloxetine. I started at 30 mg and did notice slight improvement in my mood. Then when we tapered me to the 60 mg dose, I developed Serotonin Syndrome and could not move a muscle for two days because my entire body became rigid. Then we completed a gene test to determine what class of drugs was best for me. As it turned out, all of them except the tricyclic antidepressants were considered very dangerous for me to use. There was nothing in between as an option. After a little over a year, I could no longer handle the depression and insomnia and was weaned off the Clomipramine. We tried Lyrica for the GPN and it has since been working well. I recently began seeing a psychiatrist because my depression returned soon after I developed Fibromyalgia. This depression caused a shift to Excoriation Disorder alongside my OCD. We decided to try Amitriptyline with the permission of my neurologist to treat both the depression and GPN. Therapy has been helping with my OCD and excoriation symptoms. It’s been going much smoother than the Clomipramine ever did! Tricyclic antidepressants can work well, but you just have to find the right one!
Wowwww. This might actually be exactly what I need in my life. The Melancholic depression hit really hard with me and I definitely feel like I could use this. Thank you Dr. Tracy Marks🙏🏽
Hey bro, since we are on the same boat, can i ask you, did you try them and did they work? For me SNRIs don't work really well
Emperor Lelouch it is work with you or it is the same ???
Setraline and ami also good
For me ssri works but not that well but when I am on ssri (sertaline 50 mg )+dothiopine 25 mg + modafinil 100 mg it works perfect for me
Another use for tricylics that's very much still relevant in their use in treating functional GI disorders. I developed functional dyspepsia after having my gallbladder removed. It's been an ENORMOUS struggle getting my psychiatrist to sign off on prescribing a TCA or co prescribing a low-dose one alongside an SSRI because, in his view, tricyclics are dinosaurs that have been replaced by the SSRIs and SNRIs. It's a pity that there isn't great cross-talk between the various medical specialties!
Her videos are amazing. She makes me feel so calm.
Your videos are amazing. They are extremely helpful and informative. Thank you.
I always look forward to your videos! Hope you are well, Dr. Marks! 😊
Yay thank you Ceecee. I'm glad you're here. I hope you're doing well too. ❤️
Just saying hello. :) I really appreciate the down-to-Earth manner in which you discuss what can be - to some - difficult topics. As someone who has dealt with mental health issues for much of my life, I took several psychology classes in highschool and early college because I wanted a way to find out what was "wrong" with me. However, it was not particularly fruitful because, as you have explained very diligently, we cannot diagnose ourselves. After seeking the help of a mental health professional, I have narrowed my scope of inquisition to the specific condition which I have been diagnosed. You have provided a great deal of insight and have given me the ability to ask my doctor the right questions to get the best treatment. Anywho, just saying hello, and also thank you.
My psychiatrist just suggested I add 5mg Trintellix to my 30mg Vyvanse. $350/month copay after $100 discount in the United States. It costs $33/month in the United Kingdom. I’m hesitant to pay that much.
i have it for free within standard insurance.
How interesting i have also been prescribed Trintellix 20 mg first, plus Vyvanse 40 mg now, but Trintellix did not have any effect, & made me more suicidal.
I have a dr's appointment tomorrow i want to change to Tolvon or Remeron (mirtazapin) or Zoloft (sertraline).
Im wondering if SNRI is better due to my concentration & executing what needs to be done...? (ADHD).
But my anxiety & procrastination is overwhelming getting shite done, & im all on my own.
Good luck on your journey mate :)
Tay Zonday? What you doing here homie?
Yes both of those meds are brand only so they are expensive. That's one of the big problems with prescribing the new medications if a person either doesn't have insurance or they have a high deductible plan.
@@DrTraceyMarks Yeah I’m stuck with Washington State’s top ACA/Obamacare plan. I MIGHT only owe the high copay up to a $2000 annual deductible. Their marketers figured that if they charge low premiums with a higher deductible, patients will be intimidated by sudden high billing and elect to get less care VS a predictable premium that adds up to the same.
That's interesting information. Throughout my battle with Major Depression and GAD I've been on 8 separate antidepressants. Out of all of those I would have to say, hands down, that Cymbalta or Duloxetine was the best at managing my depression. The main drawback for me and the reason my psychiatrist took me off was that I gained almost 100 pounds during my time with it. Being a relatively small-framed person this was beginning to cause issues in my joints especially my knees and ankles due to the excessive weight gain.
I am currently on Trintellix 20 mg. which supposedly is the only FDA approved antidepressant NOT to cause weight gain but it still does somewhat, but not at much as the Cymbalta did. But the Trintellix doesn't do a lot for my depression, though. YMMV.
----------------------- med that was most effective.....had most 'side effect' .....the trade off....best wishes
Thank you Dr. Tracey Marks! I am sure my best friend struggles with depression, especially since she has been dealing with her mother's alzheimer disease. Her therapist adviced her to see a psychiatrist, but she has traumatic experience with her mother's medication changes and sees herself potentially at the the same situation in the future. As a result she is really afraid of visiting a psychiatrist and I would like you to advice me on how I could maybe help her overcome that fear. Thank you again for everything! You are a treasure!
If she's already seeing a therapist, then the therapist must think med's may be helpful for her progress. It may be easier to see a primary care doctor and many of them will treat depression. I would talk about meds as a way to feel better faster and a complement to her therapy. If she doesn't want to take a med, then she'll need to keep up the work in her therapy for a while until she can process her fear about the future. If she doesn't see enough progress, she may change her mind about seeing a doctor.
@@DrTraceyMarks Thank you so much for your answer! I am wishing you all the best!
Thank you, doctor. I hope in the next episode you will talk about panic attacks, agoraphobia, and new medications. 🙏
I found your video after looking for info on amitriptyline for treatment-resistant(so far) chronic nerve pain. While I don't need this medication from a psychiatric perspective, your video was informative and of good quality. Thank you!
I'm from Brazil and doctors here still highly recommend tricyclics. at least in my experience, I've taken some of them treating myself for depression in the last ten years.
Loved the video! I'm a huge nerd on those topics, would you consider making a video on MAO inhibitors? 🥺 It would be really interesting to find out if they still get prescribed
They still get prescribed and EMSAM is a retake on an old medication. Transdermal delivery avoids most of the dietary restrictions.
I started taking medication today as recommended from my psychiatrist.
Hello, I found worthwhile relief many years ago while taking Surmontil, a tricyclic. Not so on the more recent SSRI’s. Thanks for the great work you do Tracy.❤
Your videos have helped me so much! Thankyou so much for your service! 😊
Very informative video- I’ve been on Nortriptyline for many years and it has been a lifesaver. Very helpful with stomach and sleep issues.
I’ve been prescribed 10mg for IBS but I’m scared of the side effects. Did you get any?
What about orthostasis? Iam taking NT 10mg and this has been bothering me. I think I might just stop taking the medicine since I have health anxiety and this has been making me a lot more anxious 😅
gis! if I like this woman! 😊 your videos are always so informative
I'm a guy who likes brass tacks, so I'd usually err on the side of naming compounds after structures, but when you have a drug class like TCAs which includes opioid agonists (tianeptine), dopamine releasers and reuptake inhibitors (amineptine), norepinephrine-dominant reuptake inhibitors (protriptyline), and serotonin-dominant reuptake inhibitors (imipramine), used to treat conditions as diverse as neuropathic pain, depression, migraine, narcolepsy, and ADHD, PERHAPS it's not as clinically relevant that they have three fused rings as it is that they have pretty varied and unique pharmacological profiles and effects.
wow, perfect timing for me! now it makes so much sense why I was prescribed SSRI for migraines at first. thank you for the video and I love the owls on your shirt ☺️
Look into upper neck instability/subluxation of the atlas if other treatment doesn’t help enough. Some good info on u-tube. It could be related to migraines…
@@BR-lq6bk thank you, I just read a bit about it and it is insightful! haven’t heard about micro-traumas that can be caused by prolonged sitting before, that could be my case (a desk job and nerdy hobbies). any tips what to do about it/how to get evaluated?
THANK YOU so much for your videos! After trying all different types of newer antidepressants for years I only found out that clomipramine worked perfectly for me by chance. I only wish I had this type of information that time!
Thanks
My mom still takes a small amount of Nortriptyline daily, and can't function well without it. This was a helpful video.
Can I ask if your mom had side effects from Nortriptyline? I’ve been prescribed 10mg but really scared to take it.
Hey @@beckys6260, she takes only 10mg at night to help her sleep. For her, more isn't always better. It's so helpful she can't not take it, and has been taking it for maybe 20 something years in this small dose. AFAIK 10mg is a pretty small dose. If there's a reason it was prescribed for you, I think you should give it a go. I believe people can take up to 150mg per day, but then in those doses maybe the side effects are more problematic. Start at your 10mg, and pay attention to how you feel after several days. I suspect you don't need to be as concerned as if you were taking more. Best of luck and I hope it helps you!
@@jkeiffer Thank you so much 😊
@@beckys6260 Been almost 2 weeks, so I'm checking up on you. How's it been going with the meds?
@@jkeiffer one thing I’d chip in to that is that notriptyline has slight sedative effects so maybe that’s why more isn’t necessarily better for her. Have you talked to her about her taking it in the morning (or whenever she needs to be up and alert) instead?
Tricyclics have been the best antidepressants so far for me! Atleast for Neurotransmitter imbalances
Hi doc Tracy. The moot cause of stress, resentment, anxiety, rage, fear of trigger, and developing of defensive mechanism all lays in dealing with Narcissistic and Negative personality people .
I have back pain in my neck and lower back. I was on the opiate protical for a while. I also see a doc for depression. Doc put me lamatragine that helped with my mood swings, I get incredibly angry very easy. Last trip I asked the doc about Tramadol (one I've taken before that works GREAT for both) but it's a narcotic, venlafaxine, and amitryptiline. Gotta love the internet research, lol. She opted for amitryptiline. Took first pill, 25mg at dinner at a restaraunt. An hour later it wiped me out. EXTREME fatigue (covil level fatigue), blurry/double vision and I fell asleep at the restaraunt. Wife drove me home and I woke up 15 1/2 hours later. "hangover" all next day, more postictal in feeling. Still have hope, cut dosage to 1/4 pill trying to work up. If I can't, I'll try the other SSRI you recommended. Does one usually build a tollerance to side effects like some do to gabapentin?
Tramadol does help for a lot of things all in one single pill. It was amazing when before it became rescheduled. F n shame.
I definitely agree amitriptyline works well as long as you take 2 hrs before actually going to sleep so you are not as groggy in morning. I was taking 50-75mg
I’ve tried almost everything including ECT, TMS and Ketamine infusions. Started acknowledging covert abuse and emotional neglect since childhood. This lead to finding an upper cervical specialist. Turns out I have a subluxation of my atlas (c1) probably stuck in misalignment for decades. Head injury, trauma, stress, posture, whiplash, abuse, repressed emotions can be a factor. It affects the vagus and cranial nerves. A regular chiro doesn’t do this type of adjustment. No cracking and popping but very precise shifts. A slow process but some get relief after just a few. Adhd meds helped some with depression, chronic fatigue, dissociation. Eventually was on too much and thought was getting better but started having flashbacks and maybe psychosis. Journal, meditation tapes or have someone you trust to talk to might help. Structurally if the brain isn’t getting proper blood/oxygen flow and fluid draining can cause all kinds of issues including anxiety, depression, cognitive function, migraines, gastrointestinal… Some good info on u-tube on upper neck instability/vagus nerve. Worth looking into. Also looking into Psyllicybin studies. Wish that was legal and available. So sorry so many are going through this. Keep searching and hoping we all get relief…
Sounds similar to what is happening to me. Tried many kinds of antidepressants, ketamine, nothing worked. Now I just started taking vyvanse and it's helping somewhat, but if it stops being effective I'll try mushrooms. Luckily I'm in Brazil and magic mushrooms are legal here
@@honey...salguod sometimes they give ADHD meds to people with depression depending on your symptoms. You know nothing about my treatment, dude.
I’d definitely give psilocybin (magic mushrooms) a go (or at least some serious thought) but pharmaceutically try a tricyclic.
Ohmyfrickingod. I was switched to clomipramine from nortriptyline for BFRBs combined with balance issues to treat both conditions with one medicine. I was previously taking nortriptyline for balance issues. No wonder the clomipramine made my balance worse again and how validating that it actually wasn't in my head that I got dizzy again from the switch. Lovely summary!
Most all psychiatric drugs have bad side effects..many are very toxic.
@@blairsterling6141 okay but that is not related to my comment. I was born with a diagnosed balance disorder. It is not a side effect of my medication. It was diagnosed in infancy. I didn't have any psych meds in infancy. Not sure why you felt the need to comment that on my comment specifically when she said clomipramine can be bad for people with pre-existing balance issues.
@@blairsterling6141 also as an FYI. I was dizzy 22 hours a day before meds. Nortriptyline actually changed and saved my life. I eat healthy, drink lots of water, and I exercise. Contrary to popular belief, not all diseases are caused by meds. A lot of them are helped by them. With every medication, there is a cost-benefit analysis. That's an incredibly important analysis to make and review with a qualified professional and support network on your team who can help with the evaluation of weighing the options. That analysis is very personal and individualized to every case. Blanket statements are seldom the case for all people.
@@natalieedelstein ..everyone is different..explain how Pamelor saved your life please...in detail...defend your statement please..thanks.
@@blairsterling6141 not my job but if you can imagine the room spinning 22 hours a day, how do you work, eat, get dressed, stand up, walk, shower, acquire water, finance medical visits, go to school, mentally feel, make any friends to support you, finance help to feed you and bring you water, finance a place to live, finance transit to get to medical visits or afford food or water, fill out paperwork to get that support, feel like your life is worth living, etc......
Thanks Dr Tracey, your videos are always helpful. Finally got the courage to write this, I'm living with bipolar 1 and I have been on medication for years, one of which was imipramine which helped with my bedwetting(onset was my teen years, my parents say from very young age I had never wet my bed) however it has been discontinued in south africa and now nothing(i.e Vesicare) works, I've even tried all types of therapy and urologists say there's nothing wrong with my system hence my psychiatrist put me on imipramine(found 200mg to be the perfect dose) because she suspected its more psychological, can you please do a video on this with other possible antidepressants that can help with this because I'm a 22 years old living with someone and it's depressing having to wakeup to a wet bed... thank you!
Would you be able to do a video on Autism and ADHD/ADD in woman. Much appreciated 🙏🏼 ☺️
Your videos are remarkable and I love them! I'm been off antidepressants thankfully for 15 years because I don't need them anymore, but when the depression was there only Tricyclics would help. I would love to have you do a video on MAOIs. (I think that is what they are called). I know they are very dangerous antidepressants, but very effective if taken as prescribed with the right diet. Any thoughts? Thank you.
Dr. Marks,
Thank you you very much for your many concise and helpful videos. I am wondering if you might discuss the MAOI medications, such as Parnate, in a near future video? Thank you!
Be aware that tricyclics can have different, but just as disruptive, effects on sleep. They also can trigger Mast Cell Activation Syndrome in the same ways that SSRIs can. That could increase your seemingly-allergic reactions and make you quite anxious. That could lead you to be given a benzodiazepine. And the game goes on....
Your awesome!!!! Keep on helping people
Thank you Eli. I will! ❤️
So i'm bipolar and have been since 1989 after a very traumatic helicopter crash into the ocean triggering huge changes in my life, not diagnosed or treated until 2007. I have had 32 medication and dose changes since 2007 20 of them through our lovely pandemic. When i'm depressed they( the VA) always want to start SSRI, which after a couple days of taking it i have a complete violent breakdown., so we don't do that after the fifth time, even giving me benydryl with SSRI, nope. I think i felt more normal for the 17 years of struggle than the 15 years treated. I'm so sensitive to medications my psychiatrist literally said recently no more changes due to my side effect sensitivity. So i get to live life feeling outside my body, concentration getting worse and my very good memory going away. I tend to lean on the depressive side, the manic seems to be flattened by my drugs, stuck on Invega and Lithium and sometimes klonopin, Thank You for the Mandala coloring idea, it has really helped with sudden onset anxiety and i have been able to get back to building my 7 foot robot. I hope one of these days they make progress on bipolar, i'm 53yrs old hoping real fast.
Is my next step vyvase?? Survived childhood medical abuse prob cptsd....Diagnosis MMD. I am stabilized on Prestiq 50mg (Effexor) no changes 2 yrs. It raised my BP, which I have to get under control. Got rid of crippling pulses of adrenaline and anxiety throughout the day. Mild ASD, chronic depression, rumination, inattentive ADHD, sometimes slow slurred speech, no drive to do anything at all (not even watch TV, play video games). I feel like my brain will not wake up, do not breathe enough, zoned out and falling asleep..... Did blood vitamin tests, thyroid. Tried and failed w ssris.
Pristiq isn’t Effexor
Thanks for explaining all this so clearly
I have tried ssri’s and nothing has worked for my depression until they put me on a tricyclic antidepressant. It was a life saver
The problem is people who are actively interested in trying tricyclics and MAOIs often know more about them than the doctors (who are trained to be more in favour of SSRIs than stronger antidepressants and have been for the best part of 30 years). The reason why SSRIs are more frequently prescribed these days over older antidepressants isn’t because they work better but because the side-effects are likely to be less severe and there’s less chance of successfully suiciding oneself on O.D. than with the more potent older drugs. Tricyclics (besides maybe amitriptyline) might not be first-line treatments anymore for those reasons but they actually are much, much, much more effective in testing these conditions than SSRIs (which can be next to useless for a lot of people) could ever be.
How much time take to kick in and you feel better?
@nicolemàcholz9778
What is the name of tricyclic
are you on
I don't think they prescribe this in the uk anymore.
a
I was prescribed nortriptyline by a psychopharmacologist (had already tried 40+ meds at the time) at a time when I had been suicidal for over a month. Sadly it made me psychotic, it was scary. That was maybe 15 yrs ago. Still feeling the same these days, I’m treatment-resistant to everything. Psy recommended clomipramine a few months ago but due to my awful experience yrs ago I never tried it. ECT DBS or Vagus nerve implant is all I have left, I have low hope about those. Only ECT is insurance covered :( Really I wish I had access to psilocybin, I think it’d the one thing that would save me from near total dysfunction as of late.
-Kind regards
Hi, you can order them online in Canada even though they are illegal here- maybe the same for you where you are?
And also want to say I am sorry no meds have worked so far and how much I admire you continuing to search for your right treatment ♡ I hope you find it and recieve many blessings!
Compassion to you in your suffering Tzadik
I’ve tried almost everything including ECT, TMS and Ketamine infusions. Finally found an upper cervical specialist. Turns out I have a subluxation of my atlas (c1) probably stuck in misalignment a very long time. Head injury, trauma, stress, posture, stuffing emotions can be a factor. It affects the vagus and cranial nerves. A regular chiro doesn’t do this type of adjustment. No cracking and popping but very precise shifts. A slow process but some get relief after just a few. Adhd meds helped some but was on too much and didn’t realize what was going on. Worth looking into if structurally the brain isn’t getting proper blood/oxygen flow and fluid draining. Some good info on u-tube on upper neck instability/vagus nerve. Also looking into Psyllicybin studies. So sorry so many are going through this. Keep searching and hoping we all get relief…
They grow out of the ground. Use the internet to find out about growing and you never know. Some may pop up near you😉. The spore prints are not hard to get and legal depending on where you live. Great hobby, it's saved my life and I find growing them has been a big part of my recovery. Stay strong, mush love.
I have severe OCD and also depression. I’ve tried SSRIs and SNRIs but the ONLY med that worked and saved my life was Clomipramine (Anafranil) I take 50 mg and it made wonders for me. It reduced my OCD symptoms and my depression disappeared. I am not saying that it works for everybody, but there is definitely room for these type of meds in nowadays too.
It’s often a case of getting what you bargain for, in an allied principle-vein to higher-quality products being more expensive. Tricyclics may come with worse side-effects with SSRIs but not without reason. Sometimes a person just has to tolerate severer side-effects in favour of better symptom-relief and decide for themselves if it’s worth it.
Clomipramine’s a wonder-drug for many. I’m glad it’s worked for you.
Thanks
If I'm not mistaken, in a large meta-analysis, amitriptyline was found to be the most effective antidepressant- outbeating all the SSRIs in symptom relief. Escitalopram (mostly) seems to be okay for me. But I find the TCAs interesting: in being less selective it seems they're both more effective while also more loaded with side effects by targeting unwanted receptors like histamine and the municinergic system (may have butchered some of that - just a guy with depression who's tried to learn too much about all this!)
Not sure where your depression falls on the scale but you may know more than most physicians that treat us. Sad it is 2022 & we are still experimenting. Yes? Maybe I'm just not realizing we are still in infancy.
There are all sorts of positives to tricyclics (and MAOIs but the likes of phenelzine are extremely difficult to take so I wouldn’t recommend that as even a third choice for most people). That’s why I find it funny when all these people like Joe Rogan and baby-wave doctors who don’t know about tricyclics who make no hesitation in pointing out that SSRIs might not be as effective because ‘depression isn’t necessarily a direct cause of serotonin imbalance yo.’ We know. That’s why tricyclics and other antidepressants of that ilk came before them in the first place. The effectiveness of SSRIs can’t be denied but many, many people benefit from the more traditional, potent agents.
@@Anonymous_Anon882The classic MAO inhibitors get a bad wrap. Phenelzine is generally harder to tolerate than Tranylcypromine, but as long as you can stick to a diet that isn't nearly as restrictive as people think, most people can tolerate it well.
@@vwvqr that’s the one. I may have said this elsewhere but taking a compatible tricyclic antidepressant with an MAOI (in other words anything besides imipramine and more especially clomipramine) can totally avert what tyramine-hypertensive risk exists. So if someone’s taking nortriptyline, trimipramine, amitriptyline or doxepin (for example) with phenelzine or tranylcypromine they might not need to worry about what few genuine dietary restrictions exist at all.
I wouldn’t be scared of taking phenelzine if I needed it. Side-effects can potentially be rough with any medication but I’m the sort of person who’d air more on the side of phenelzine than tranylcypromine. Bupropion and desipramime (and I guess nortriptyline) are there for people who need a stimulating antidepressant. I think Parnate’s just a more intense version of that. The amphetamine thing can worry people who like to avoid anything vaguely reminiscent of speedball-highs or the stuff that Walter White’s been known to cook up. I feel like in that sense it’s really a class B drug (which I’m not saying is a bad thing, just off-putting for people who don’t really like anything stimulant). Getting through a can of Red Bull can be heavy enough for some people.
@@Anonymous_Anon882 The pharmacology is too complex for me to comment, but quoting Ken Gillman, taking Nortriptyline and Tranylcypromine makes Tranylcypromine safer. I believe it was in reference to some prescribers refusal to prescribe any TCA and MAOI together due to imagined risk of serotonin syndrome (aside from with those you mentioned). As someone on Nortriptyline, Tranylcypromine and Lithium though, I still mind what I eat and don't really test it too much, but I have never had a particularly noticeable tyramine reaction.
Hai madam.
Thank you very much for your contribution to the mental health.
I'm a dentist from India and i love your videos very much.
Please make your book available in India.
I'm also very curious to know what you are providing as bonus for pre-ordering of your book.
Kindly share your PayPal account details so that I can pay you directly and get your ebook through email.
Finally thank you very much.
You deserve lots of appreciation and recognition worldwide.
🙏🙏🙏
150mg of Venlafaxine augmented with 20mg of Amitriptyline per day has been working better for me (history of substance abuse, depression, social anxiety) than countless other combinations of antidepressants and neuroleptics. Tricyclics are a godsend and don't have any noticable side effects for me (probably due to the low dosage).
This is amazing, once again.
SSRIs never did anything for me but make me angry and fat. Just started a TCA for my OCD and my life feels changed. Its always worth trying something if your doctor is on board as well :) i was scared to try but glad I did.
Which TCA are you on,and what dose
I was put on amitriptyline 20 years ago for chronic muscular pain. A few years later I was switched to nortriptyline because the side effects (especially dry mouth) were less severe. On balance I think it has worked for me (I've spent periods at different doses and periods off of it)
What was AMI dosage? How much Nortrip? How was the switch over from ?
@@truehuman9449 It was quite a long time ago so I don't remember exactly. I don't remember the switch being a problem at all though
I like the lighting in your more recent videos. It's more natural like your early videos.
Thanks for noticing Sia. I moved some things around in my studio and I think the light is a little further back. I've also been using white light on the background instead of color.
Stunning video
Just wow
Low dose Desipramine (Tricyclic antidepressant) has really helped my chronic severe acid reflux!! when nothing else would. Very cool.
Oh that's great!
wow- interesting ..have similar thing going on . will ask doctor.God Bless Kate.
My doctor change my meds from fluoxetin to bupropion because fluoxetin caused me anorgasmia.
Would you please talk about libido issues and anorgasmia?. I feel like sexual life is important for people who has depression and not many doctors seems to notice. Also because I thought anorgasmia wasn't a big deal compared to improve in other areas, but I just mentioned to my doctor and then she changed my meds and helped me a lot.
Thanks again Dr for your videos ☺️
Thanks for the suggestion Gaby. I'll add it to my list. Yes, anorgasmia can be a big problem with the SSRI's, but not with Wellbutrin. I'm glad that switch is working for you.
I have had the same problem when on SSRIs and SNRIs, since switching to Clomipramine is has majorly helped in this area but not entirely fixed it either.
A friend of mine stopped with their meds completely as they had made him impotent and so therefore miserable and putting a strain on his relationship.
So yeah I am totally keen for a vid on this problematic side effect too
I too, had sexual disfunction on prozac. ED, or antiorgasm. Every antidepressants I have tried ruined my sex life. Lack of sexual satisfaction led me into deeper depression.
Just a suggestion: your psychiatrist can prescribe cyproheptadine to combat this sexual side effect, take it about an hour before sex and it eliminates the anorgasmia.
@@yvonnebarash9373 ..thank you ! Men and women need orgasms almost daily. It is nature at work. It is a miracle and beyond wonderful. Women and men deserve maximum pleasure.
Warning ⚠️ to anyone to takes a tricyclic: taper if you stop taking your medicine. If you stop abruptly, then you will fall into the PITS Of DESPAIR 😭😭🥴🥴.
My neurologist prescribed me a small dose of amitriptyline as a migraine preventative. I didn’t see any improvement in migraines. I started having these itchy, pins and needles sensations all over my back when I took this medication. My doctor didn’t advice me to taper when I told him I wanted to stop this medicine. Ugh ☹️
Thank you for sharing
Wow. Not only are you a very interesting and knowledgeable but you’re spot on. I have severe OCD manifesting itself in hypochondriasis or psychosomatic disorder. I started taking Anafranil in 1992 right after it was approved in the United States and it is the ONLY drug that kept a severe case in check. I was taking anywhere from 50mg to the maximum dosage of 250 mg. It gave me my life back. So much so that when I was diagnosed with Renal Carcinoma I just said ok, how do we treat it and wasn’t upset at all.
Unfortunately a year ago I had to stop taking Clomipramine (Anafranil) because I have benign prostatic hyperplasia and Anafranil or Clomipramine is an anticholinergic drug and is a no no for BPH so I’m stuck taking prozac and my hypochondriasis is out of control and I’m getting physical symptoms that are manifesting themselves on my skin and in other ways.
I am so desperate that I’m willing to go to my urologist to have my prostate removed just so I can take Anafranil.
Again I have listened to many psychiatrists and you seem to really be compassionate and incredibly well informed. Thank you.
Oh my, Lazer! First off, that's amazing that Anafranil worked so well for you for almost 30 years. Congratulations for being a cancer survivor. I hate that you still got one of the few conditions that make you not be able to take the medication and that prozac failed you. I can see how you would want to consult with your urologist - it's not easy for people to relate to how debilitating OCD symptoms can be. If your urologist doesn't think it's a good idea, you may want to look into Transcranial magnetic stimulation for OCD. I haven't treatment someone who's gotten it, but I think it's better than the SSRI's.
@@DrTraceyMarks Thank you so much for your reply and in such a timely manner 😊.
What exactly is TMS Dr. Marks? Is it shock therapy?
@@lazerlazer It's a little different from ECT. I talk about both in this video ua-cam.com/video/O09eRuYbqPU/v-deo.html I don't know if I mention TMS for OCD in this video because that protocol is new. TMS started out being used for depression only.
@@DrTraceyMarks Ok much appreciated again Dr. Marks. Your very kind.
This is very informative. Thank you.
I"m glad, thank you.
Just watching your videos is having an antidepressant effect
I bought a tricycle but pedaling is really hard. On the plus side, I'm a deeply bitter and cynical old man, so seeing people suffer cures my depression. Even if it's me suffering, while trying to ride a tricycle. "This SUCKS. Bwah ha ha ha!"
So yeah. Tricyclic antidepressants worked for me.
i am on Seroquel Fluvoxamine and Wellbutrin (and some heart meds). i have a diagnosis of Autism OCD Bipolar and possibly CPTSD.
Can you please make a video about vitamin d and depression, ptsd.
Enlightening! Thank you ❤️
Glad you enjoyed it!
After trying a quite few ssri’s and not getting on with them I was put on the tetracyclic mirtazapine. For me they were perfect, no noticeable side effects and they help me sleep and eat.
Thanks alot Mam ❤️, your Videos helped me alot and i guess i know what to do.
My pleasure 😊
I’m taking doxepin rn for anxiety/depression, It’s a tricyclic antidepressant. It’s weird that they aren’t used often because of their side affects but I’ve actually had FEWER side affects from this than from “newer” antidepressants
Which is exactly why it’s often better to make an informed decision on the knowledge that you can scale down/switch if the side-effects become more than you can feasibly tolerate than let your doctor put you on the lowest possible dose of a softer drug because of “side-effects.” Your tolerability bandwidth is yours and something only you’re going to fully know.
Are you still taking it?
The SSRIs weren’t doing it for me. It seemed like they gave me bad headaches, but my main problem was that it took away my happiness and my sadness. I had no highs or lows at all. Just emptiness. I take Remeron (mirtazapine) now and that does it for me. I think it’s considered a NaSSA and it’s an antihistamine too. Usually when I try to go to sleep at night my thoughts are going like crazy, but the Remeron helps put me to sleep. I’m also underweight and the Remeron makes me hungry, so that’s another good thing it does. The only thing with Remeron is you have to plan to take it at least 12 hours before you plan to wake up (basically take it at 8:00pm if you plan to wake up at 8:00am) otherwise you will feel and be like a zombie for a couple of hours after you wake up. I also take Buspar (buspirone) for GAD and OCD (my obsessive issues are worse than my compulsive issues) but I haven’t been taking it long enough to see/notice anything. I like that it’s a non addictive way to treat anxiety disorders though.
The Remeron also doesn’t “fix” my depression. It helps, but I am currently in a major depressive episode and I still have really bad days. Living with major depression is a lot like living with a disease in the sense that some days I have flare ups where it’s really bad and other days where it’s still not good but a little more manageable. It is just such an exhausting thing to constantly go in and out of episodes over the years and wonder if it’s ever going to end. I try to be hopeful but it’s hard and it’s especially hard to go through college when I’m so ill like this.
I was on sertraline for a while and switched off them due to upsetting, severe, emotional dulling. What's the point of treatment if it takes all your joy away too? Just zombie shuffling through life sux
I was on Remeron and it took away my ability to orgasm. Ruined my sex life with my wife
What is your dosage? I was on 45 mg and had no problems over the day with tiredness. Now i am on 30 mg and am tired and getting out of bed is harder. My sleep is better though. I dont want to go back and think about going lower again.
@@notyourinterestbelong1074 which drug. ?? Please be specific in your posts... tell all details for us to learn.
@@blairsterling6141
Mirtazapin. But i also take bupropion in the mornings and got from 300mg to 150mg. So maybe it is a combination of both.
My dr started amitrytiline and nortriptline and it’s been good.
Thank you for this video 😍
We need more psychiatrists to advocate for MAOI medications. They are extremely efficacious.
I was sad that she essentially erased their existence by saying that TCAs were the first antidepressants…
Oh boy if only people knew what they were getting into. Correction we need more evidence on its benefits vs risk, we barely have any on SSRi/SNRI, Antidepressants. We currently have no evidence beyond 6 months. You are talking about recommendations for meds and procedures known to disable the brain to treat a mostly made up diagnoses which have zero medical or scientific interventions in... Go ahead, next time you speak with you're psychiatrist ask them how the DSM manual (We are currently uo to DSM-5) was created... It's puesdoscience, every diagnoses in that book was voted in, no tests, no studies no scientific evidence anywhere for their existence which is why psychiatry is the only field where you can go to 5 different psychiatrist and walk out for 5 different diagnosis. It blames my mind how willing people are to do note their minds and bodies without evidence. The only pieces of evidence avaiare observational reports and opinion pieces along with some anecdotal reports which are all useless in medical Stastical overviews. But what's more concerning is that many of the permanent symptoms can take years to pop up. Once you undergo this form of treatment the clock starts ticking, many end up with the inability to talk properly and or bedridden for decades due to these drugs. Again they work by disabling the brain. That's something you want to cheer on? Zero evidence? Good luck with your treatment.
@@GCT1990 you don't know jack about psychopharm.
I have spent a little time trying to understand my depression medications. Which ones work and which ones I can not tolerate. This lesson here by Dr. Tracy has cemented my knowledge and assumptions. SSRI and SNRI all make me feel like I am , for want of a better word, on dirty meth. Feelings are dire. The cyclics work wonders for me. I have 15mg Mirtazapine + 50mg Amitriptyline at night. Mornings 15mg Mirtazapine and I am back to normal. SSRI and SNRI send me crazy giving me, only, the motivation to plan my funeral.(paradox) . Why?
Thanks dr tracey
Me a eye surgeon ...but love ur grip on the subject
Thanks a lot Chickoo. I'd be lost with eye surgery talk. 😀
What do you think about working through negative emotions and getting to their roots.
I think it's very important. I have a view videos talking about that. Here's one of them ua-cam.com/video/jIYqcX-7oCI/v-deo.html
I’m on fluoxetine for pmdd and amitriptyline for insomnia.
Thank you for another very well explained topic. What is your take on sulpiride as antidepressant? I was prescribed sulpiride for irritable bowel syndrome but I noticed that my depression got better with it. However at 200mg dosage it gave me itches so I was forced to reduce back to 100mg a day. Can I keep on taking it long term?
Very helpful video.
I love your wardrobe!
Have you ever listened to Dr Peter Breggin? If not, you and everyone else should!!! Especially before recommending or taking ANY medication
I wanted to put in a request. I’ve been watching your videos for a while now and they’ve been helping me a lot! Could you do a video on bipolar and Seroquel? So many people like myself get put on Seroquel during a big episode and end up taking it ongoing, which then leads to brain problems. It got so bad that I couldn’t learn anything new, or remember what time it was. I’m now tapering down but I feel lost as to what kind of medication is best for a bipolar who isn’t currently in a major episode. The only thing currently holding me to medication is my inability to sleep. I just feel like bipolar and medication is much more complicated than one would think. I would love to hear your input on this topic. Bipolar is very prevalent in the state of WA.
Seroquel created your brain problems... most antipsychotics CAUSE brain malfunctions. CAUSE! ... psychiatry will never admit this...read Dr. Peter Breggin please.
TCAs are not usually prescribed here in Australia due to high toxicity related deaths in case of an overdose. Every time I’m admitted to hospital they end up having to order them from pharmacy - which is about a 12 hour wait - because they don’t carry them in psych wards. It’s really unhelpful for anxiety or for severely suicidal patients like myself. I was put me on them as a last ditch effort to help with my treatment-resistant depression. It didn’t do diddly, and I’m experiencing worsening dark thoughts & poor sleep quality (it’s taken at night).
In your experience, of course :)
Fellow Australian here with a totally different experience
I'm on amitriptyline and mirtazapine for three weeks now and I think this combination works well for me. I tried SSRI's in the past, either didn't work (ladose) or had a lot of side effects (zoloft , seroxat). Definitely worth trying something different.
SSRIs have always been comparatively weak antidepressants compared to the real nuclear bullets (tricyclics, MAOIs, venlafaxine, possibly etc.). Amitriptyline’s always worth a go if side-effects can be mitigated or tolerated.
HELLO DR. TRACY. I WOULD APPRECIATE IT IF YOU COULD CREATE A SHORT SCENE OF SOMEONE WITH A MENTAL PROBLEM AND WHAT THE PERSON MUST DO IMMEDIATELY. I THINK PEOPLE WILL RELATE MORE TO IT AND APPRECIATE SOLUTIONS
Hi Healthy life. Thanks for the suggestion, but I wouldn't know where to start with that. I give examples here and there in my videos and the examples fit the topic. I work better starting with a topic rather than starting with a random behavior and trying to deconstruct. But there may be some mental health channels that do that.
I’m on this now because my doctor suspects the SSRI fluvoxamine I was on was causing me a low WBC. It’s working ok so far, but I’m only on 25 mg a day before bed. Anxiety is mostly gone and sleep has improved, but focus hasn’t fully returned. It’s only been a few weeks, so maybe I need some more time with it before deciding to increase my dose. I had been off of fluvoxamine for 4 weeks before deciding to go on this instead.
Hello. To be honest, I don't know who I can turn to. Maybe you can tell me something.
I am 19 years old. Two months ago I was prescribed carbomazepine and sonopax (anxiety, depression, intrusive thoughts). The dosage was low. These medications were helping me. But then a traumatic event occurred and the medications became less effective. The doctor decided to prescribe clofranil 25 mg 3 times a day. On the second day of taking it, after sleeping: I got out of bed and just fell over, because I couldn't feel my legs, I had a burning sensation in my head, a terribly fast heartbeat and sweating. My mother and I called the attending physician and she cancelled all the medications. The first three days the condition was just awful, it was like everything was changing in my head. My blood pressure was jumping from 85 over 50 to 150 over 100. Now it's been 14 days since I've taken anything. The burning has gone, but what remains is a strange condition: impaired tactile sensations, sleep disturbance, a strange feeling in my head, a feeling of weakness in my limbs and their remoteness (as if I do not feel them periodically or feel them remotely), drowsiness, etc. Before taking clofranil my condition was very good: I went to the gym, studied, did voluntary work.
I can't understand what could have happened in my head that now I have this condition. And I don't know if it will go away or not. Can you please tell me what it could be? Is there any way to fix what has been disturbed in my head?
Dr., I have complex PTSD and Generalized Anxiety. How can I stop waiting for the other shoe to fall? I have no thoughts of worry. It's just a constant feeling. I don't need a reply. Just a video or link would be good.
I take 45mg mirtazapine. I have cptsd, psychotic depression with psychosis, strongest dose but it's a
tetracyclic antidepressant. They tried sertraline and it didn't work, within days I had a major reaction that wasn't even listed on the side affects.
Imipramine reminds me of pricking my cat's pads with a diabetes lancer.
Actually 🤓 @33:00 When I was in the 18-24yr range, I got thoughts of suicide that were never there before or after I was on that specific ssri and I was not made aware of that black box warning until years after that event. So I think it's fair to say there is more correlation than is hypothesized here
Amitriptyline is great for post concussion symptoms
I like tricyclic verses SSRI medicine. The side effects for me on SSRI were horrible
THANK YOU!!! I take clomipramine (I also take anti-psychotics too) and my psychiatrist monitors my BP and other stuff but more and more I have been getting severe, debilitating, painful edema and another side-effect you described, but I had no idea my meds could be the cause. I have been having tests done by my GP but I should take that up with my psychiatrist asap!
Although that really sux as I have been on and off just about every medication and Clompramine is the only thing that helps me gain control over my severe OCD (official diagnosis) and self harm.
Cut me a break universe...damn!!
Do you think it's worth me discussing switching to those next gen options you mentioned towards the end of the vid? Do you know if they could be just as effective in treating severe OCD?
I too take Clomipramine! Have you developed any memory issues?
@@aryan991000 I was having more memory issues before the switch to clompramine. But mine were due to some kind of dissociation or fugue directly linked to my anxiety. These meds have helped me gain clarity and control in a lot of areas, but not fixed it entirely, I still gotta work at it with CBT and ERP.
But everyone is different so I would still talk about memory issues with your psych. Also, you mentioned that you are on 25mg pd. I am on 175mg pd, plus 150mg Quetiapine so it's possible we have very different experiences. But memory issues are an important red flag so you should tall to your doctor about it
The issue that I have been having that Dr TM mentioned in the video is problems with my bladder and urination.
Hi! Could you maybe do a video on Adderall making you tired instead of focused for ADHD? Every dose I’ve had sends me to sleep.