Posted by rick_number1001@yahoo.com on August 17, 2001, at 2:10:11
In reply to Re: Treatment for Social Phobia w/o MAOI ,benzo, SSRI?, posted by jb on March 29, 2001, at 10:26:02
Hi, I'm a 34 year old male.
Untreated I'm diagnosed very severe SP.I have found many treatments very helpful since
starting med treatment age 26. Currently I take
60 Nardil + 2.5-2.75 Klonopin + 75-100 Provilgil
(modafinil).I recently heeded the suggestion of a friend and
put up a website, it is at www.socialfear.com.I'd welcome any comments, input.
I think most people can achieve relief of most
symtoms with medication. Habits may not change
as easy, but many will just with meds. Age
makes a difference I think.My generally most recommended meds include:
Nardil
Klonopin
Provigil
ZoloftHowever, there are so many meds that can be used
in comination to produce similar effect.
I think Klonopin is probably the single most
effective purely for symtoms, but it may increase
depression and cause cognitive difficulties in
long run. High dose Nardil may (much like Paxil
and celexa and Zoloft) cause sexual side effects
which need to be treated with another med
to elimate or reduce. Ultimately for moderate
and severe SP I believe polypharmacy often provides
the best results. I don't like taking meds
for it's own sake, but for good effect. I like
CBT which I started about 6 months ago in group
form and now individual.Thanks for all the good info in previous posts!
great site!
> Hi, Sal. Thanks for your thoughtful response. I think I should take another look at Mirtazapine, at a minimum. Regarding Venlafaxine, I'm wary of its high level of sexual dysfunction (see PubMed article, below). With Nardil, I already have sexual dysfunction, but I also get a high level of relief from SP. Desipramine, although an agent with predominant nor-adrenergic activity, I understand to be less efficacious than Fluvoxamine, which is less efficacious than Nardil.
>
> So, I guess I'm trying to get around the sexual dysfunction of drugs with prominent 5HT2a activity (mostly SSRI's, venlafaxine), and the prominent cognitive/memory impairment of benzo's. Sometimes, I feel like a dog chasing its tail.
>
> I did see a post where someone was claiming Adrafinil as a 100% solution for Social Phobia, but I guess I'd like to see others making similar claims. Separately, I know more people are trying various "cocktails" of augmenting and combining agents to address social phobia, such as using Modafinil to offset the decreased alertness of Klonopin. However, research on PubMed has shown Modafinil does not reverse the short-term amnestic effect of Klonopin. The conclusion is the amnestic effect is not related to the decrease in vigilance or psychomotor impairment of benzo's.
>
> Oh, well, guess I'll continue to chase my tail.
>
> Thanks.
>
> JB
>
>
>
>
>
> ____________________
> Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.
>
> Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F
>
> University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain. angelluis.montejo@globalmed.es
>
> BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
>
> Publication Types:
> Clinical trial
> Multicenter study
>
> PMID: 11229449
poster:rick_number1001@yahoo.com
thread:57815
URL: http://www.dr-bob.org/babble/20010814/msgs/75353.html