Welcome to my updated and much improving web site.
I am Dr Ken Gillman, a retired practicing psychiatrist who does research and has published many scientific papers in the field of neuro-pharmacology [link]. I am an internationally acknowledged authority on Serotonin Toxicity (ST), aka Serotonin Syndrome (SS), and also an expert on Neuroleptic Malignant Syndrome (NMS), MAOIs and drug adverse reactions and interactions, especially those relating to MAOIs, TCAs, SSRIs and SNRIs.
I live in tropical north Queensland, Australia: hence the web site name ‘PsychoTropical’ (psychotropic: a drug that effects the brain).
This web site provides freely accessible information and expert critical and sceptical analysis, especially about ST, neuroleptic malignant syndrome (NMS), monoamine oxidase inhibitors (MAOIs), tricyclic anti-depressants (TCAs), SNRIs, SSRIs, mood stabilisers, anti-psychotic drugs (FGAs & SGAs) and also about other aspects of psycho-pharmacology (e.g. the enormous bias produced by the preponderance of pharmaceutical-company-sponsored drug trials). It is intended to be understandable and useful for both doctors and non-medical enquirees.
All the web site content is independent of pharmaceutical companies, is funded by me, with a boost from some gifts [see “Friends of PsychoTropical”] and is my knowledge, experience and opinion.
See the introduction below for information about the philosophy and motivation for this website. But most important, if you think it is good then do all you can to spread the word, forums, tweets, blogs, whatever! Your action as an individual spreading the word will do more to promote the site than any other action, thereby making it easier for others to find the information.
Feedback is important for me. I encourage anyone with questions and comments to make them. Without feedback about the usefulness of what I write, my motivation to write is diminished.
Those suffering with depression tend to be disinclined to interact, and I appreciate that extends to communicating via Skype. However, please remember that the voice part can be one way (me), and anyone who feels unable to talk can just type questions and responses, as ‘instant’ messages (no different to an email). That way I get the advantage of not having to type, which eases the strain on my bad neck.
Please use the “Contact” button in the menu to get in touch: my reply will have my Skype address in the signature, if you are sending a “Skype” authorisation request make sure you put in some text indicating the nature of your communication, or I may block it on the assumption it is from a generous pulchritudinous lady in Africa who wants to be my special friend!
Introduction and Background
The motivation and philosophy that persuade me to make the effort to maintain this website is to help both doctors and patients, their families and friends, navigate through the mass of mis-information they are confronted with: that necessitates experience and a reality-based and sceptical analysis. Unfortunately mainstream medicine is almost as prone to distorted information and wishful thinking as is alternative health care. Mis-information is promulgated by powerful financially wealthy interest groups, especially the pharmaceutical companies, and others, including medical practitioners themselves (status, self-importance, wealth).
Papers that are critical of, or not in agreement with, the mass of literature pumped out by pharmaceutical companies just get lost in the morass of misinformation. Even papers published in the most prestigious journals, like my review of the tricyclic antidepressants, attract relatively little attention and, more importantly, have a small impact on opinion and practice. I believe the situation is such that my efforts are now better directed to putting quality information on the Internet rather than getting more papers published in scientific journals. Well informed consumers can probably drive change much more effectively and quickly than direct attempts to re-educate doctors.
I aim to provide some balance to the biased information from ‘commercial’ sources and give some viewpoints and information that might otherwise be less accessible or not available. Most sources are dependent on the excessively prominent viewpoint that is manipulated and spread by pharmaceutical companies. It is very important to know how strong the evidence for that statement is, so see my theme “commentaries”, several of which deal with this vital issue [link], e.g. “Why Most New Antidepressants Are Ineffective: And How Pharmaceutical Companies Have Deceived Doctors”.
Publishing scientific papers is a lot of time consuming work, especially when you cannot type much because of a bad neck. I am not a professor, although people often address me as such. They assume that anyone who has published as many papers as I have must be a professor, which is a justified assumption. I have published more original papers that most professors have. If my alma mater still conferred honorary “Doctor of Science” degrees I have been informed I would probably have been granted one.
My publishing efforts have now wound down; I am putting my time into improving the web site. My papers are listed under my publications [link]. They include recent reviews covering the interesting story of my discoveries about methylene blue, which we have shown to be a monoamine oxidase inhibitor, as well as my review of the pharmacology of monoamine oxidase inhibitors (MAOIs), much overdue since this is a neglected area; and my review of neuroleptic malignant syndrome (NMS). My review paper about tricyclic antidepressants, in the British Journal of Pharmacology (10), has been influential and is the most cited paper in this field over the last five years and one of the most highly cited papers from that prestigious journal. It is available free on their website http://onlinelibrary.wiley.com/doi/10.1038/sj.bjp.0707253/pdf [see also Science and scientific information].
The tide of neglect might be turning with MAOIs. Various other recent papers (11-19) tackle some different aspects of this subject. Also the limitations, or ineffectiveness, of the much hyped ‘new’ drugs are gradually beginning to be more widely appreciated.
Misleading, Biased and Poor Science
Misleading, biased and poor science is a major problem throughout the medical field, about which I continue to write. Since my essay on antidepressants [link] a very large number of news stories and scientific publications have continued to document these serious problems, although sadly, and shamefully, the medical profession do not appear to be leading the debate, or action, in relation to correcting these enormous problems
It may be useful for people who search for information on the Internet and participate in forums etc. to realize that high(er)-quality information and full copies of papers are often much more easily available than many people seem to imagine. Although I do not participate in forums etc (bad neck/typing difficulty). I see, or have reported to me, comments from such sources. These reveal that people frequently do not have the knowledge or skills to access information or to judge its quality. Since that is a widespread problem, as illustrated by the climate change debate, I have written a commentary on the topic to help people understand how to access and evaluate such information [link]
I have published many original scientific papers over a period of 30 years [see 'Publications']. I ceased clinical work as a practicing psychiatrist in 2006 because of my neck trouble. I continue to do independent theoretical research relating to my interests in clinical neuro-pharmacology and psycho-pharmacology and I also offer, for a fee, expert medico-legal opinion and advice on serotonin toxicity (ST), serotonin syndrome (SS), neuroleptic malignant syndrome (NMS), drug-drug interactions, drug side effects and related topics [see expert medico-legal section].
A Word about References and Presentation
Generally speaking, because this material is in electronic form and will be printed (only occasionally, I hope) by individuals, I have not sought to save space by using abbreviations or closely spaced text. I subscribe to the view that no more than 65 characters per line makes reading easier, as does using a serif font. Spacing between lines is generous, which reduces the problem of losing your place as you scan down the page. A white background is glary and provides excessive contrast, making it tiring to read, so we use a parchment colour background.
I provide more references in this material than I usually would in a review paper to be published in a scientific journal. There are various reasons for this:
Ø There are no space constraints, some readers will have limited access to obtaining references and therefore alternatives will make it easier to find something additional to refer to, for those who desire more information
Ø Anyone can quickly locate the reference in the National library of medicine database and see the abstract. Sometimes reading several abstracts on the same subject tells you as much as a full copy of one single paper. I probably read at least 20 abstracts for every full copy of a paper that I might decide to obtain
Ø A greater selection of references gives a better impression of the range of opinion in the literature. I generally list references which I think are good papers and try to avoid including what I think are poor papers.
Hyphenation of Complex Compound Words
The brain recognizes whole words, rather than strings of letters, so a typeface (like Times NR) that has less clear separation of words is harder to read (so check your system preferences and available typefaces). This factor may be especially relevant for those reading text that has new and unfamiliar words, i.e. many of my readers. So, I prefer to hyphenate complex, unfamiliar, compound words, because that aids word recognition. See: http://en.wikipedia.org/wiki/Hyphen
Try reading these two lists and see which is easiest, for me it is a no-brainer.
Gluconeogenesis, lipopolysaccharide, neuropsychopharmacology, neurotransmitter, electrophysiological, thermoregulation, histopathological, hypodopaminergic, hyperdopaminergic, cerebroventricular
Gluco-neogenesis, lipo-polysaccharide, neuro-psychopharmacology, neuro-transmitter, electro-physiological, thermo-regulation, histo-pathological, hypo-dopaminergic, hyper-dopaminergic, Cerebro-ventricular
I hope your reading on my website will be informative, and I urge you to give me feedback because that is what motivates me to continue communicating information in this way.
1. Gillman, PK, Advances pertaining to the pharmacology and interactions of irreversible nonselective monoamine oxidase inhibitors. J Clin Psychopharmacol, 2011. 31(1): p. 66-74.
2. Gillman, PK, CNS toxicity involving methylene blue: the exemplar for understanding and predicting drug interactions that precipitate serotonin toxicity. J Psychopharmacol (Oxf), 2011. 25(3): p. 429-3.
3. Finberg, J and Gillman, P, Pharmacology of MAO-B inhibitors and the cheese reaction, in Int. Rev. Neurobiol., M Youdim and P Riederer, Editors. 2011, Elsevier Inc. Academic Press.: Burlington. p. 169-190.
4. Gillman, PK, Neuroleptic malignant syndrome: half a century of uncertainty suggests a Chimera. Pharmacoepidemiol Drug Saf, 2010. 19(8): p. 876-7.
5. Gillman, PK, Combining antidepressants: Understanding Drug Interactions is the Sine Qua Non. Adv Psychiatr Treat, 2010. 16: p. 76-78.
6. Gillman, PK, Neuroleptic Malignant Syndrome: Mechanisms, Interactions and Causality. Mov. Disord., 2010. 25(12): p. 1780-1790.
7. Stanford, SC, Stanford, BJ, and Gillman, PK, Risk of severe serotonin toxicity following co-administration of methylene blue and serotonin reuptake inhibitors: an update on a case report of post-operative delirium. J Psychopharmacol (Oxf), 2009. 24(10): p. 1433-1438.
8. Gillman, PK, Triptans, Serotonin Agonists, and Serotonin Syndrome (Serotonin Toxicity): A Review. Headache, 2009. 50: p. 264-272.
9. Gillman, PK, Monoamine oxidase inhibitors, dietary tyramine and drug interactions (V2.2.1). http://psychotropical.com/pdfs/maois_diet_full.pdf, 2011: p. [accessed Jan 2011].
10. Gillman, PK, Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol, 2007. 151(6): p. 737-48.
11. O'Brien, V, The Monoamine Oxidase Inhibitors: Relics Reconsidered. Psychiatr Ann, 2011. 41: p. 176-183.
12. Shulman, KI, Fischer, HD, Herrmann, N, Huo, CY, et al., Current prescription patterns and safety profile of irreversible monoamine oxidase inhibitors: a population-based cohort study of older adults. J Clin Psychiatry, 2009. 70: p. 1681-6.
13. Mallinger, AG, Frank, E, Thase, ME, Barwell, MM, et al., Revisiting the effectiveness of standard antidepressants in bipolar disorder: are monoamine oxidase inhibitors superior? Psychopharmacol. Bull., 2009. 42(2): p. 64-74.
14. Fawcett, J, Why aren't MAOIs used more often? J Clin Psychiatry, 2009. 70(1): p. 139-40.
15. Stahl, SM and Felker, A, Monoamine oxidase inhibitors: a modern guide to an unrequited class of antidepressants. CNS Spectr, 2008. 13(10): p. 855-70.
16. Krishnan, KR, Revisiting monoamine oxidase inhibitors. J Clin Psychiatry, 2007. 68 Suppl 8: p. 35-41.
17. Youdim, MB, Edmondson, D, and Tipton, KF, The therapeutic potential of monoamine oxidase inhibitors. Nat Rev Neurosci, 2006. 7(4): p. 295-309.
18. Cole, J, This Month’s Expert: Jonathan Cole, M.D. Reflections on the Use of MAOIs. The Carlat Psychiatry Report, 2006. 4(11): p. 4.
19. Amsterdam, JD and Shults, J, MAOI efficacy and safety in advanced stage treatment-resistant depression--a retrospective study. J Affect Disord, 2005. 89(1-3): p. 183-8.