Medications for Depression & Bipolar | Robert D. McMullen, MD



I'm Robert McMullen I'm a psychiatrist I went to Georgetown Medical School which was a wonderful place and I did my residency at Columbia Presbyterian Hospital in psychiatry which is a great research institution I've been in practice for 36 years and primarily with using psychopharmacology using medications to treat various psychiatric illnesses including manic depression schizophrenia panic disorder obsessive-compulsive disorder and various other anxiety disorders and probably what I treat the most of is is treatment-resistant depression both in people that are unipolar that means they only have depressions and people that are bipolar and people that are bipolar are of two types bipolar one is somebody who's manic-depressive and have such a big eye that they are hospitalized for it or it should have been announced but there's a lot of other people who have just mild eyes and we gonna let my poll or two but in both cases the depression found in these bipolar patients can be harder to treat then then unipolar depression because the antidepressants can cause them to swing a little and have more mood swings than ever let me get down to the antidepressants usually the first antidepressant we use is an SSRI like prozac or so loft or celexa citalopram or lexapro and also some related medicines like effexor and cymbalta that hit two receptors rather than just one those are the standard things that we use and you start out on one of those and go up slowly frequently you cannot get a person all the way to normal on that one medication and many of us think that if we've got some benefit from the medicine we shouldn't just switch to another medicine we should maybe stay on that medicine and add something else to it the most common thing to add is a different antidepressant called wellbutrin or you propia it works by a completely different mechanism so that using them together your you end up using not such a big dose as you would if it just had there's one so you have less side effects because you're on lower doses of two different medicines but it's more effective because it's going at the depression from two different directions and zoloft and wellbutrin were used so much together in the past that they were called well offed by some people a sort of a joke if the SSRIs and/or wellbutrin do not work the most powerful antidepressants are called mao inhibitors or mao eyes and these are antidepressants called Norvell or par nay or em Sam of which the generic is allegedly these antidepressants raise three different transmitters in the brain and that may be why they're more effective the main problem with them is that you have to be on a special diet where you avoid eating cheese and other aged foods because if you ate a big chunk of cheddar cheese you met your blood pressure would go up for two or three hours and it could be dangerous and you also have to avoid taking any medication then that works on serotonin the Meo inhibitors also have the problem that they can cause significant amount of increase in appetite so you can have weight gain now in addition there's a medication called the mikveh or lamotrigine which was approved for depression I believe in 2003 I started using it in 1996 and it is a medication that came out for seizure disorders for epilepsy about 1994 and 1995 all around the world and the neurologists noted immediately that it often brought people out of depression very nicely even though it might not have helped that person with their seizures so they told their psychiatric friends who started using that off-label and in the company then did research to prove it worked on it and it became fda-approved for depression it works a little better if people are a little bit bipolar it seems but it could work in anybody and the big advantages of lamotrigine is there's no sexual dysfunction no sexual side effects there's no weight gain and usually there's no sedation and the dose you use is really way below the dose you use for seizure disorders which is another reason it has such low side effects so I have mentioned major categories of antidepressants SSRIs wellbutrin mao eyes and lamictal lamotrigine when those or the combination of those things have not brought you all the way to normal there are many other augmentation strategies that we use and one of them is to add a little thyroid hormone particularly citing them rather than there's two thyroid hormones sytem al and synthroid which are t3 and t4 but it it is the sytem l for some reason that has much more antidepressant effect another thing we use is atypical antipsychotics like low doses of Cyprus or abilify or sera well and now there's new ones called with salty and free one and a couple of others and those often have an antidepressant effect another thing one can add is lithium and low dose not the 1200 or 1500 milligrams a day that a manic-depressive might think with just a hundred and fifty milligrams a day to which nobody usually has any side effects and you don't have to do any monitoring of the blood and there's quite a few other augmentation strategies that I could go into but they're too long to talk about now if you have any questions feel free to call me at two and two three six two nine six three five two one two three six two nine six three five or look on our website you

22 comments

  1. I am very sensitive to meds, even cytomel gave me panic attacks, I did much better on bioidentical T3 but can not afford the doctor vists to prescribe as it's not covered by insurance…can you expound on tms effective for depression

  2. please please listen to me i have to say just for leagal reasons it is in my opinion that your better off without the medications any that are for bipolar.. If you want to go threw life having every doctor saying that you have A.L.S. then take the meds. I took the medication for pain because I didn't want narcotics. when I got off 3 years later I could no longer keeps my body from tremoring. i almost lost my voice. i have to drink for breakfast lunch and dinner. I have met many many people at the MDA that did the same as I did. if you think im ok because there's nothing going on now, just get off the meds and you will see in a couple of months. PLEASE SAVE YOURSELVES from this. I owned my business grossing over 3 million a year. now im living off of social security. DONT LET THIS HAPPEN TO YOU PLEASE! for the love of everything HOLY dont do it please. Doc warn your patients. I find all of you doctors are just worried about getting that kickback from prescribing.

  3. I had used EXFEXZOR for 5 years doctor has switched to Valdoxan and lithium, I am getting worse and thouggt of suicide and I bored of everythinng.

  4. lamictal, has been a wonder drug for me, had been severely anxious linked to bad depression, now im actually happy. 🙂

  5. shrinks = pseudo-science + big pharma scams. These charletons will prescribe dangerous meds after just 15 mins to make a diag. They now have over %10 of the population on psyche meds. The drugs only work on schizoprenic patients, the rest is just bull shit and actually cause more mental illness than they cure. Don't buy into it. They also like to prescribe highly addictive benzos for sleep and anxiety. Seems lots of people who uses benzos wake up in jail after blacking out in car accidents or just other bizarre behavior. These clowns make $250K a year just writing scripts and sitting on there ass, while telling their golf buddies how they are saving crazy people. I'm a former victim and it just makes me sick !
    TMS and ECT also bullshit, do your reseach before letting some quack attach electric shock to your brain. My god people are gulliable.

  6. These doctors are the only ones who treat a body organ that they can’t see It is all guess work Dr I know you mean well but this profession has had no major medical breakthrough Dr the new wave is diet plant based More and more Dr are backing such approach We need to fix the cause not just treat the symptom

  7. Unfortunately, despite possibly good intentions, this Dr. sucks (but not any more than 90%+ of the others out there). Do yourself a favor and check out https://psychotropical.info/.

  8. Treating nutritional deficiencies with supplements and anti-inflammatory diet works perfectly. Run away from psych meds. Run far away.

  9. Dr..have you have found any link between severe depression and auto immune disease? I became so depressed after being diagnosed with active epstein barr and have went down hill for 8 months..I cannot function due to a mind numbing depressive state..I have terrible mouth, teeth and gum pain (no dental issue found), digestion has slowed to a crawl and bloated with weight gain, no appetite (have to force myself to eat 1x per day (usually soup or salad) dry skin that burns, eyes blurry and become very bloodshot, (ALL mucous membranes affected) muscles are weak and toes on one foot have gone numb and I now limp along with several other issues.I have a positive ANA and it seems as if my body is attacking itself (tsh in normal range)..I so apologize for this long disorganized post! My main questions are 1) Are these common issues of severe depression? 2) Have you seen people improve by taking plaquenil or a biologic drug for systemic auto immune disease? Thank you

  10. I stopped my seroquel and lithium 2 weeks ago , now im so depressed , my heart rate so high, heart feels funny is scary

  11. Doctor, would you please make a video about insomnia, especially as it occurs in depression and bipolar disorder? It's got to be the worst part of depression because of the continual exhaustion and the inability of the brain to get the rest it needs to replenish neurotransmitters and function properly.

  12. Dr. I have watched many of your YouTube clips and let me start by saying you are very helpful, knowledgeable and informative and I am sure you have helped many people through YouTube. I have suffered life long depression and anxiety to varying degrees which is obviously worse in times of angst. I have seen about 4 psychiatrists over the years and I wish even one of them was as knowledgeable as yourself.
    A couple of things I would like to ask is regarding your thoughts on RIMA medications ie moclobemide etc.
    Also the long term effects of TMS in relation to cancer of the brain? Even though scientists haven't proven a correlation between cell phone use and brain cancer with the electro magnetic radiation that is emitted by cell phone use, the jury is still out. Therefore, what are the risks of the electro magnetic field emissions from TMS as a risk factor even though I realise it is only used for a short period of time compared to cell phone use cumulative over years.
    Greetings from Australia.

  13. Hello sir,I have depression..I feel worry and I thinking about one thing again and again.. my worries disappeared for 2 or 3 days then continue one week.. please suggest me any medicine… thanks

  14. I am 56. My Dr. took me off of Clonazapam but my anxiety is through the roof. Is is safe to take it again?

  15. I have been on Wellbutrin for a little under a year. It worked alright but the last few months my depression has gotten progressively worse. I seen my PCP yesterday and she prescribed me Zoloft to take along with my Wellbutrin. I took my first pill yesterday and as soon as I did I felt as if I couldn't focus, I was extremely hyper, shaking, my brain feels like it's just pinging in a million directions. I took it at 3 yesterday and still feel the same as I did right after I took it. I didn't sleep at all last night. I did some research online and read alot of things about hypomania and bipolar episodes. I have not been diagnosed with bioplar, but it runs in the family my father has it, his father etc etc. I have an appointment to see a therapist next month, I put a call into my doctor because I just don't feel right and she's not in today. Can you give me any idea of what I should do?

  16. I have been on lamital for years on and off but now a full year and I google reviews from people and they say the same thing. It does affect my sex drive and causes weight gain slowly but it does. I don't get it? How much does it cost to call you and will I get you directly?

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