Introduction to the professional pages section
Welcome to the professional pages section of my website which is accessible to professionals, via login.
My publications, my expertise, and my website, focus particularly on these areas: psychotropic drug interactions (especially serotonin toxicity, about which I am a widely acknowledged expert); MAOI antidepressant drugs; and the safety of various drugs and drug combinations in the treatment of depressive illness.
Below is an introduction to key commentaries on the website that are of particular importance and interest for doctors and medical scientists.
The purpose of the ‘PsychoTropical’ website is to produce accurate independent evaluation and opinion concerning the pharmacology, interactions, and effectiveness of relevant drugs, and to educate doctors, and the public, about them. I have published extensively about these subjects in peer reviewed journals in many disciplines (see publications menu).
A prime objective is to raise knowledge and awareness concerning the lamentable underuse of MAOIs and to engage in various strategies aimed at preventing them becoming pharmacological dinosaurs.
For instance, I have published a thorough (and the only recent) analysis of the extensive data concerning the tyramine content of different modern foods. This analysis is the foundation on which clinicians can individualise the advice they give to patients about the likely level of diet adjustment advisable in relation to their particular dietary habits ; the supplementary data for that paper is [here]. Other details are in this section.
Much of the content of the website is based on my published papers, often expanded and amended in ways which make the material more understandable to a wider range of readers.
Seminars and tutorials
I have recorded a number of YouTube educational videos and I also give tutorials or talks via Skype, or other similar platforms like Zoom, on request. If you wish to ask about a seminar or tutorial for your academic department, ‘journal club’ etc. please contact me to discuss this (generally speaking a donation to help the costs of website will be expected). You can see existing YouTube videos in the main menu.
Serotonin toxicity, although it is well documented and explained by basic pharmacology, toxicology and animal experimental work, is still poorly dealt with in the psychiatric literature, and poorly understood by doctors. It is difficult to explain why current medical texts and sources contain so much misinformation, some of which is seriously consequential misinformation. This misinformation permeates the whole range of clinical guidelines and computerised drug interaction warnings, producing a chaotic effect on sensible clinical management: groundless concerns about medical and legal liability, and disputes between professionals, such as doctors, nurses, and pharmacists, are the inevitable result. The most likely explanation is that adequate education in pharmacology and toxicology is not being delivered successfully, either at the undergraduate or postgraduate level.
For anyone who wishes or needs to understand psycho-pharmacology, I recommend that learning about serotonin toxicity is an excellent teaching and educational exercise, because one has to understand most of psycho-pharmacology in order to understand ST. That makes it a continually stimulating and challenging exercise which has major benefits in terms of understanding drugs, drug actions, and inter-actions, and in honing one’s ability to manage the clinical pharmacology aspects of patient care.
There are major problems with medical science publishing which have become so serious that much of the scientific literature is now of minimal value to anyone, especially practising doctors — we have reached the stage where it is hard to know what to rely on, because vested interests have become so deeply embedded in most of medical education and publishing.
Although I have published various review papers in the last 20 years, I have now ceased publishing scientific papers because the considerable amount of time and trouble involved does not have a sufficient payoff. I now take the view that educating the public and doctors is better accomplished by publishing material on my own website. For instance, if you do a search on the Internet for information about the much discussed ‘Lancet 21 antidepressants meta-analysis’ you will find my comment on my website comes up first in a Google search (exactly where it appears will vary a little depending on the search string used). That demonstrates Google is being moderately successful in promoting quality content in its search results.
The process of peer review, that has formerly been believed to maintain the quality of the scientific literature, now no longer does that reliably — if it ever did. The items published on my website will be rated, not just by Google algorithms, by also by post-publication review by experts who can log on and give a rating and comment.
As part of my effort to improve teaching and knowledge about MAOIs I started the ‘International MAOI expert group’ in March 2018 which now has many eminent members and is undertaking various tasks and strategies to advance the above objectives. The group has already written and published a major statement concerning the use and availability of MAOIs , and was endorsed by more than 80 eminent researchers in the field.
I think of myself as a clinical neuro-pharmacologist: however, since my retirement I have come to appreciate, even more keenly than before, that the scientific literature, even in supposedly prestigious journals, cannot be considered to be reliable. This has become a sufficiently consequential issue that I have found myself writing about the extensive problems with the corporatisation of tertiary education, through to the particular problems of scientific publishing, and difficulties with the multifaceted aspects of undue financial influence over the publication and quality and refereeing of scientific papers.
It is simply not possible to assess the scientific literature without recognising that it is now beset with major limitations and flaws. Accordingly, I highlight several key commentaries relating to these issues.
From my pleasurable position of relaxed retirement, here in the warm and picturesque tropics in North Queensland, Australia, it seems that so many of my erstwhile colleagues have become so busy and overburdened (and disillusioned) that they no longer have time to step back and think, to contemplate the big picture, or to ‘smell the roses’. I wonder how much this unrelenting busyness, that appears to embroil so many people, has to do with the difficulties that permeate our field?
Now that the MAOI expert group is up and running, my next task is to update and coordinate the information about MAOIs available on my website (as of the end of 2019, that process is well underway. What is already there has been added to bit by bit over the years, and has now been reorganised and coordinated.
The first commentary for 2019 is a general introduction explaining how MAOIs are so different, and why they are still so important: see here.
The next update outlines the misunderstandings and misconceptions that have contributed to the restricted use, and underuse, of these drugs. Here are a few examples for starters:
They cannot be combined safely with tricyclic antidepressants (false, with the exception of clomipramine and imipramine)
Serotonin toxicity is possible with a wide range of drugs (false, only potent SRIs)
It is difficult to swap to and from other drugs (false, in fact one can safely co-administer them with any therapeutic psychotropic drug except one that has significant potency as an SRI)
That they need to be ceased before anesthesia (false) & that opioid analgesia cannot be used (false, except for opiates that are SRIs, such as tramadol and meperidine (pethidine)
One cannot give epinephrine, or alpha1 agonists (false, but a dose reduction may be needed)
The contention that they cause elevated BP and should not be used in patients suffering from hypertension (false, they lower BP and ameliorate hypertension) etc.
Another key aspect of MAOI interactions that I am actively working on updating is the interactions with ‘releasers’: that is drugs like amphetamine and ephedrine. If there is anyone who thinks they would like to help me with that commentary, please get in touch. Mentioning that reminds me that Prof Rosenbaum has promised to help with an authoritative commentary about anaesthetics and MAOIs — this is still causing more angst and disruption to patient care than is warranted.
There are quite a few things that will benefit from clarifying and updating — watch this space.
1. Gillman, P.K., A reassesment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths. J Neural Transm (Vienna), 2018. 125(11): p. 1707-1717.
2. Gillman, P.K., S. Feinberg, and L. Fochtmann, Revitalizing monoamine oxidase inhibitors: A call for action. CNS spectrums, 2019: p. http://dx.doi.org/10.1017/S1092852919001196.