Thats great, every individual will be different and some will find one medication to be substantially better for them. Unfortunately, the science doesn't support a lot of the pharmaceutical companies claims about the medication and it did not outperform citalopram 40 mg/day in a head to head trial. I'm not saying people should stop using it, or not consider it after other medications have been tried. IMO the most important thing is you feel good and are doing well. Hope this helps

nothing has worked with me besides benzos. I have taken a genesight test also wich proved it...I was also hoping to try this... thank you for the info on your experience.

Hello friend, a question. Did taking vilazodone affect your erections and ejaculation? They say antidepressants cause that. But my husband was recommended to take vilazodone, how was it for you?

Completely agree. I've tried alot I'm 41 now bit in my teens tried everything. This has been the only medicine that's helped with depression and PMDD.

Generic was approved and released this year in 2022

It's here generic Vilazodone for $40 a month not too bad

@@MplsDiamond June of 2022

did the vilazodone work out?

lol, I figured people would be disappointed. You guys ask me to present evidence based scientific data and a lot of times the since falls behind the subjective user data that we have. I think it's coming but we want real data or this psychedelic thing turns into cannabis where I'm still waiting for the randomized controlled trials to prove the claims. Thanks for watching

I think this tell u something I've been saying a lot recently, Old medications are more effective and New Medications are safer but what you give up in safety you gain in efficacy with older meds. Hope this helps I appreciate the support, please spread the word about what we are doing here

@@ShrinksInSneakers this video helped me since ill be taking thesemeds soon. Was allergic to wellbutrin sadly. IMO id rather have safer meds to use the meds as a tool plus meditation and therapy instead of how paxil made me a zombie. I dont want to run from my feelings, i just want some help through the ups and downs.

If we are talking about low dose naltrexone I think the data in depression is limited. I’ve seen a lot of data on chronic pain and inflammatory disorders. If you watched my video on depression and inflammation I can see how the concept would make sense. My concern is psychiatry is filled with a history of medications whos mechanism makes sense but it doesn’t play out clinically. In short I haven’t used it but I’m not opposed to the idea and I can see why it might make sense in patient with high inflammatory markers and depression. Hope this helps

@@ShrinksInSneakers Yes actually I think you're right about not enough clinical data in relation to how it works with depression. Thanks for replying

@@Steve-qt2xm I would say I've seen more data for buprenorphine in low doses for depression but I will be seeing an eye out for more data

@@ShrinksInSneakers personally I've been taking LDN for several years and it's been a life saver i can't live without it. I get extreme fatigue and sense of impending doom without it. I'd say it manages my symptoms 70%. I am still often depressed, but I've tried coming off LDN a couple times and it was 10x worse, I was sleeping constantly and not feeling rested, brain fog, et cetera. With that being said, I would not recommend it as a nootropic or antidepressant per se, I have a chronic illness that LDN helps and that's it. Also the dreams on it are really, really cool, I filled several dream journals thanks to it and I'm filling another one.

viloxazine was horrible.. I can only describe it as catatonia. I doubt I would do any better on atomoxetine but who knows.

As options for non-stimulant ADHD treatment they are good in theory they should work for depression as well but there randomized controlled data is limited and it's hard to recommend it other than as an off label option when other medications have failed Hope this helps if you haven't subscribed to the channel please do and spread the word about what we are doing here

The right combination is Zoloft + Wellbutrin

I will see if we can get that done. Thanks for watching and please subscribe and spread the word about what we are doing here

thanks for watching and sharing your insights

We can do something like that

Trintellix & Wellbutrin has worked the best for me. 🙏🏼

There are several, serotonin interacts with 17 different receptors the most well studied are 5-HT1A and 5-HT1B. Others are also believed to have antidepressant effects depending on the activity antagonism Vs agonism. 5-HT1A postsynaptically is also known to be involved with depression treatment. Many of these effects were studied in knock out mice as a model. This is more in-depth topic that probably requires a video to fully appreciate. Hope this helps get you started.

@@ShrinksInSneakers I've been reading journal articles. Hopefully not too trouble you too much in the future: What serotonin receptors as being effected as pure agonists would be implicated in depression treatment? And the same question insofar as anxiety if you could. I'm just asking so I can get a strong foothold in my journal search on Pubmed. I'm just mainly into this as far as intellectual curiosity. I'm bipolar 2 by diagnosis but I work in a large forensic psychiatric hospital (that will go unnamed) and my interests have expanded beyond my diagnosis. I'm a big fan of Dr. Stahl. I really enjoy your videos and thank you for your response. I hope you will be able to answer my follow up questions sometime.

@@ShrinksInSneakers Since you kindly answered my question on this video thread I wanted to pose another. I, at one point, through a process of defacto cross-titration was discovered to have a very good response to Latuda and Abilify in combination (I know antipsychotic polypharmacy is generally not desirable). My dr had discontinued my Abilify without titration as it was not quite helping with my depression although it seemed to keep my mood stable albeit a "low" stable (I have Bipolar 2). I was on 30mg daily. He started the Latuda at 60mg daily and my mood improved markedly within days, nice and euthymic. Then I began to decompensate a few days later apparently as the Abilify washed out. It was decided to reintroduce the Abilify at the original dose while keeping the Latuda and about a week later I was stable and euthymic again. My notion is that the Abilify was primarily the agent binding to the D2 receptors due to it's strong affinity and that Latuda was working more on the receptors that Abilify not as strongly, but still effects, such as 5HT7. What are your thoughts on the matter? Just an idea on my part. Anyway a few years ago I developed essential tremor and the only medication that helped was Primidone. Alas due to hepatic metabolism issues the Latuda became non-existent in my system (we did labs) and the Abilify level at 30mg plunged. At 60mg Abilify I do well enough but it has never been the same. I apologize for the flurry of questions but I figured it might be a good chance to ask another. Thanks again.

It's hard to say at this time as there are only a few small studies that looked at ketamine in OCD. I would say there is more evidence right now for TMS in OCD. I think we may learn that ketamine will be a good option in the future but right now we need more data.

@@ShrinksInSneakers Thanks! I will look into TMS. Out of curiosity, which drug(s) do you normally use first for your patients with OCD? And how long should that person give that drug to work?

@@stevenj429 Important question, the standard of practice is SSRIs to start but the dose must be higher than those used to treat depression. Examples would be fluoxetine 120 mg/day, or Sertraline 300 mg/day. This should be continued for a full 12 weeks not the typical 4 weeks for depression. The next step if that does not work would possibly be a trial of clomipramine a TCA or the adjunctive use of a dopamine blocking medication such as risperidone or aripiprazole the two approved medications for this treatment.

@@ShrinksInSneakers Thanks so much for your responses! I probably should have stayed on Prozac longer. I went off of it due to sexual side effects and low motivation (Prozac increased motivation at first, then it dropped). Is there anything that can be added to Prozac to decrease these? I've heard of Wellbutrin being added to Sertraline to combat these side effects, is it safe to add Wellbutrin to Prozac?

@@stevenj429 Usually Buspirone, I have an entire video on it if you are interested check it out.

And I don’t believe in the grim reaper (maybe I should?) but there it was, red eyes too. I tried to catch naps to recover in daylight as to avoid the dark. During 1 doze off, it felt like I was hit in the head & then the bright orange brain 💥 explosion with it. I’ve felt zaps before, these are explosions. Just be careful what you wish for when deciding to try a new a/d. Always wean w/ Prozac?

right now the two things that are most effective for depression are Ketamine and ECT we might beading the new TMS protocal created at Stanford SAINT as well. The effect size for SSRIs is 0.33 and 0.36 for SNRIs. These newer medication haven't faired much better (these are low to moderate effect sizes that are used as a measure to show how effective a medication is, the larger the number the better). to put it in perspective ketamine is around 0.8 which is a large effect size

Dr there are many people with treatment resistant depression - like myself. I've seen numerous psychiatrists over the past 35 years & tried countless meds and even ECT but nothing has helped. You mentioned Ketamine & that works quickly for most & that's mainly because it's a glutamate antagonist - however my insurance won't cover it & I can't afford the ketamine IV or even Spravato. Honestly the only thing that ever helped my crippling TRD was low dose tramadol. However since it became a schedule lV controlled substance circa 14 years ago all Drs are afraid to prescribe it. I've suffered tremendously ever since for the past 14 years. If you Google tramadol reviews for depression it actually has a rating of 9 on a scale of 1-10. I understand it is a very minor pain med which some people abuse - however just because some people may abuse something why should those that don't have to suffer.... tramadol used off label for TRD is actually effective & fairly fast acting. I've even been prescribed Adderall for my TRD & that didn't help. Tramadol is just as effective as ketamine & covered by health insurance so I think it should be allowed for TRD & I wish a pharmaceutical company would run the necessary clinical trial so as to get tramadol an FDA indication approval for treatment resistant depression. I'd appreciate any thoughts or opinions you have on the off label use of tramadol for TRD.

At this time there are no randomized controlled trials on Viibryd in OCD. I can't provide much information without the data. With OCD the primary neurotransmitter is serotonin and that is why many say clomipramine is the gold standard because it's most serotonergic of the TCAs. I do not consider OCD treatment with SSRIs to be failed until the medications have been maximized 120 mg fluoxetine for example for a complete 12 weeks before deciding it's a failed trial. Hope this helps if you haven't subscribed to the channel please do and spread the word about what we are doing here.

yeah it's a lot but I want viewers to be educated on what they put in their body and all scientific research and true understanding of data requires some statistics, I do hear where you are coming from and thanks for being a part of the community

This channel targets higher level information, sorry it couldn't be more helpful. If you really want to understand what you're taking/prescribing some medical jargon is required. Best of luck