Posted by jb on March 29, 2001, at 17:47:40
In reply to Re: Treatment for Social Phobia w/o MAOI ,benzo, SSRI?, posted by SLS on March 29, 2001, at 11:28:18
Hi, Scott. Thanks for your suggestions. Unfortunately, I've tried both Parnate and Neurontin, with little effect from either. Neurontin, I tried at the higher suggested dosage, which I believe I was up to 3600 mg/day. Perceived little benefit after continued 12 weeks of treatment. A new drug. which you may have heard of, Pregabalin, is very similar to Neurontin, but, I understand, much stronger. It's also been developed by Pfizer,who has seemingly abandoned its quest to have Neurontin approved for SP, and, instead, is hoping Pregabalin will do the trick. Pfizer has been taking Pregabalin through very large placebo-controlled trials. I don't know if the research has been completed, and I have heard nothing about efficacy over Neurontin. My psychdoc told me Neurontin clears the body too fast to provide a significant therapeutic effect for social phobia, given its low potency. This is why, I believe, there were not follow-up studies to the Neurontin "social phobia" trials conducted about two years ago. So, Pfizer developed pregabalin as essentially a stronger version.
Parnate, an irreversible non-hydrazine non-selective MAOI, had very little effect, for me. There is one study on PubMed showing Parnate's efficacy for social phobia, but I've seen no other controlled research to corroborate this. As a non-hydrazine, Parnate does not increase whole brain GABA levels. Phenelzine, a hydrazine MAOI, does increase whole brain GABA levels, and this is thought to be at least partially responsible for its very high level of efficacy. Also, as far as Parnate, I had significant dry mouth (always had to carry a diet coke or glass of water wherever I went), and, worse, a noticeable slowing of my speaking pattern. Because of its relatively low efficacy, I had to increase my intake of Klonopin to combat social phobia. But Klonopin, perhaps even more than other high-potency benzo's causes substantial cognitive impairment, decreased psychomotor performance and, importantly, impaired short-term memory. Dopaminergic acting drugs (e.g., Deprenyl and Bupropion)and stimulants (amphetamine based or not), can counteract the lowered vigilance induced by benzo's, but do not conteract the impaired short-term memory. The hypothesis that short-term memory loss is related to sedation or diminished vigilance has been shown to be incorrect, according to many PubMed research articles. By the way, I've taken Parnate for periods of over two years at a time, and these side effects stay with me, unabated, until I drop it and it washes out.
I've also tried selegiline (deprenyl) at 60 mg/day, at which it non-selectively inhibits both MAO-A and MAO-B. Yet, no efficacy even approaching Nardil, though it was great for sexual functioning. Again, I think the GABA elevating properties of Nardil contribute to Phenelzine's efficacy. By the way, there is some thought that SSRIs and other serotonin acting agents show some efficacy for social phobia(generally in the 40-50% range for CGI scores of 1 [very much improved] or 2 [much improved], versus about 20% for placebo), not directly due to serotonin increase or agonism, but, indirectly, by raising GABA levels, through allopregnanolone. It's the GABAergic propertis of Pregabalin which seem to make it appear promising.
Oh, well, sometime,I should probably post a short novel about my social phobia (generalized) experiences, and the various meds and med combinations I've tried. Outside of Pregabalin (perhaps still a year or two away), my hope is directed primarily at combination (two or more of same class of drugs) and augmentation (separate classes of drugs added together) treatment. However, I'm most concerned about staying away from the benzo's, due to their cognitive effect. Yet, I need them if I can't achieve a level of efficacy greater than Nardil.
So, when I came across a post indicating Adrafinil as a 100% solution, my interest was immeasurably peaked, to say the least!!! Unfortunatley, I haven't seen anything from any other posts or anything on PubMed or just on the Internet to corroborate this. Argh!
Maybe a combinatin of Serzone and Wellbutrin? I'm sure this is contraindicated, but some pharmacologists feel they can manage some of these drug interactions. Maybe with these drugs, the 5HT1a agonist Buspar might then become effective?
The interactions among various neurotransmitters is so immensely complex, it's easy to despair in not getting to what pharmacologists refer to as "high end state functioning." With social phobia, a 60-70% solution still seems fairly unacceptable.
Sorry to run on. I guess I'm really just continuing to try to think things through in my head, as well as dream of what life would be like with a 90-100% solution.
Best regards, and thanks again for taking the time to share your thoughts.
John
> You may need to investigate Parnate, another MAO-inhibitor. It tends to have less side effects than Nardil and is sometimes just as effective.
>
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> - Scott
poster:jb
thread:57815
URL: http://www.dr-bob.org/babble/20010327/msgs/57984.html