Posted by GS on September 16, 1999, at 0:46:35
In reply to SOCIAL PHOBIA: ANYTHING BETTER THAN NARDIL?, posted by Cynthia on September 10, 1999, at 20:14:29
> HI,
>
> I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS, NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100% ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT WORKED BETTER THAN NARDIL, WITHOUT THE SIDE EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE RELEASED IN THE US (4TH QTR 1999). ALSO, UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE IT THROUGH STAGE III TRIALS DUE TO LACK OF EFFICACY.
>
> THERE HAS TO BE SOMETHING! BY THE WAY, PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
>
> ANY IDEAS?????????????????
**************************************************Yes - benzodiazapines of the shorter half life variety like ativan (instead of the longest half life type like klonopin) work well for social phobias. If you don't have a personality prone to addictive substances there should be no problem. If you take a comfortable dosage that provides you relief and if you then experience any withdrawl when the ativan fluctuates to varying degrees in and out of the system, augment with a low dose of the low side effect profile mood stabilzer Gabapentin. This will mediate any drug induced anxiety. This works well for me anyway. Bezodiazapines are not "addictive" by nature despite what some under-informed docs state (most of the highest skilled docs agree with prescribing benzos long term for treating anxiety disorders - if properly managed). If one has an anxiety disorder they should be treated with an anti-anxiety medicine! At least until medical science comes up with something better.
Sure, if you stop taking benzos there would be a period of withdrawl - minimized of course by tapering very gradually - but the alternative which is suffering with chronic anxiety is by far the worst choice. An undertreated case of anxiety is one of the closest things to hell on earth that can be imagined. I know from experience. I have the same problem as you and now I am a highly functioning individual - not worrying needlessly with the fear of the fear of anxiety so to speak - nor the fear that I'll become "addicted" to benzos.
Read the thread on Benzodiazapines if you want to find out more....
GS
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poster:GS
thread:11383
URL: http://www.dr-bob.org/babble/19990914/msgs/11629.html