Posted by bluedog on December 4, 2002, at 23:46:17
In reply to Re: Social Anxiety in OZ (Damn Benzophobes), posted by k23d on December 4, 2002, at 22:50:28
k23d
I would like to say that not all aussie pdoc's are benzophobic. I live in Australia as well (not Sydney though) and my psychiatrist was actaully VERY keen to prescribe a benzo for my social anxiety/phobia and I am currently taking Diazepam (generic Valium) on a daily basis together with 20mg of Lovan (generic Prozac). Despite my initial reluctance (because of my past alcohol abuse) to try a benzo I am now glad that I am on it. However I might add that you MUST earn your doctor's trust and take the medication EXACTLY as he/she prescribes it or you will find that your doc will quickly take your prescription privileges away.
Even though the majority of the research on benzo's and social anxiety/phobia relates to Clonazepam, my pdoc considered that there was no reason why any of the longer acting benzo's like Diazepam wouldn't be just as effective and I agree with him. There just happens to be less specific research on Diazepam and social anxiety.
He decided to prescribe Diazepam for me because he found that in his experience that Clonazepam had a greater addiction potential than Diazepam. Also, in Australia there are far greater legal restrictions in prescribing Clonazepam whereas with Diazepam he can write out a prescription for 50 tablets at a time. Also the cost of Clonazepam is apparently a lot higher in Australia than for Diazepam.
I discussed the pros and cons of the different benzo's with my pdoc. I spoke about the fact that much research has been done about the benefits of clonazepam for social anxiety and showed him the following abstracts. He felt that the research I showed him would be just as applicable to Diazepam and again I tend to agree with him!!!
If you get another Pdoc who is not familiar with social anxiety/phobia you should show him some of this research to educate him/her.
Good luck
bluedog
==================================================================================================1: J Nerv Ment Dis 1996 Dec;184(12):731-8 Related Articles, Links
A 2-year follow-up of social phobia. Status after a brief medication trial.
Sutherland SM, Tupler LA, Colket JT, Davidson JR.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Although social phobia is thought to be a chronic disorder, little is known about its long-term course in patients who engage in brief treatment studies. We, therefore, conducted a follow-up study of social phobics who had participated in a brief, placebo-controlled treatment trial of clonazepam. Of the original 75 subjects, 56 were assessed through telephone interview and self-report questionnaires that evaluated current social phobia symptoms. Information was also gathered about treatment received in the 2-year interval since the initial pharmacotherapy trial. The group as a whole showed maintenance of the gains acquired during initial treatment. On a number of symptom scales, subjects initially treated with clonazepam exhibited significantly less severe scores compared with placebo subjects. This study provides evidence of long-term benefit for social phobics when treated with a brief medication trial.
Publication Types:
Clinical Trial
Controlled Clinical TrialPMID: 8994456 [PubMed - indexed for MEDLINE]
==================================================================================================1: J Anxiety Disord 2000 Jul-Aug;14(4):345-58 Related Articles, Links
A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia.Otto MW, Pollack MH, Gould RA, Worthington JJ 3rd, McArdle ET, Rosenbaum JF.
Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
There is a growing body of evidence that social phobia may be treated effectively by either pharmacologic or cognitive-behavioral interventions. but few studies have examined the relative benefits of these treatments. In this study, we examined the relative efficacy of pharmacotherapy with clonazepam and cognitive-behavioral group therapy (CBGT) for treating social phobia. In addition, we examined potential predictors of differential treatment response. Outpatients meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria for social phobia were randomly assigned to treatment. Clinician-rated and patient-rated symptom severity was examined at baseline and after 4, 8, and 12 weeks of treatment. All clinician-rated assessments were completed by individuals blind to treatment condition. Patients in both conditions improved significantly, and differences between treatment conditions were absent, except for greater improvement on clonazepam on several measures at the 12-week assessment. Symptom severity was negatively associated with treatment success for both methods of treatment, and additional predictors-sex, comorbidity with other anxiety or mood disorders, fear of anxiety symptoms, and dysfunctional attitudes-failed to predict treatment outcome above and beyond severity measures. In summary, we found that patients randomized to clinical care with clonazepam or CBGT were equally likely to respond to acute treatment, and pretreatment measures of symptom severity provided no guidance for the selection of one treatment over another.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 11043885 [PubMed - indexed for MEDLINE]
==================================================================================================1: J Clin Psychiatry 2001;62 Suppl 1:50-3
Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder).Jefferson JW.
Madison Institute of Medicine, Inc., and the University of Wisconsin Medical School, USA. JeffJ@healthtechsys.com
Both benzodiazepines and conventional anticonvulsants have been evaluated as treatments for social phobia (social anxiety disorder). Among the benzodiazepines, clonazepam is the best studied, although there is reason to expect that all benzodiazepine anxiolytics would be effective for this condition. Among the anticonvulsants, gabapentin and pregabalin, an analogue of gamma-aminobutyric acid (GABA), have been shown to be more effective than placebo in double-blind studies. Other than a small negative open study of valproic acid for social phobia, there is a paucity of information on whether other anticonvulsants might be useful for this condition.
PMID: 11206035 [PubMed - indexed for MEDLINE]
==================================================================================================1: Can J Psychiatry 1993 Nov;38 Suppl 4:S122-6
Innovative uses of benzodiazepines in psychiatry.Pollack MH.
Harvard Medical School, Boston, Massachusetts.
Over the last three decades, a greater understanding of the phenomenology and etiology of illness has fostered progress in psychopharmacology. While research has yielded important new psychopharmacologic compounds, the field continues to benefit from the discovery of innovative clinical applications of established agents. For instance, benzodiazepines--among the most commonly used medications in the pharmacopoeia--have demonstrated their efficacy in the treatment of a wide variety of syndromes. Recently, much attention has focused on the use of high-potency benzodiazepines (for example, clonazepam, alprazolam, lorazepam) in the treatment of panic disorder and mania. This paper presents the uses of benzodiazepines to treat other conditions, including psychotic and agitated states, social phobia, obsessive-compulsive disorder, pain syndromes, seizures, drug withdrawal and side-effects induced by antidepressants and neuroleptics.
Publication Types:
Review
Review, TutorialPMID: 7905781 [PubMed - indexed for MEDLINE
==================================================================================================1: J Clin Psychiatry 1991 Nov;52 Suppl:16-20 Related Articles, Links
Long-term treatment of social phobia with clonazepam.Davidson JR, Ford SM, Smith RD, Potts NL.
Psychiatry Outpatient Program, Duke University Medical Center, Durham, NC 27710.
Twenty-six socially phobic outpatients were treated with clonazepam for the relief of symptoms. At evaluation, which took place after an average of 11.3 months of continuous treatment, 22 (84.6%) patients showed good improvement and 4 (14.4%) showed no improvement or were not recovered. The dose declined over time, from a peak mean of 2.1 mg/day to a mean of 0.94 mg/day at follow-up. Side effects are described, along with individual case descriptions that illustrate important aspects of the use of benzodiazepines for the treatment of social phobia.
PMID: 1757453 [PubMed - indexed for MEDLINE]
==================================================================================================1: J Clin Psychiatry 1994 Jun;55 Suppl:33-7 Related Articles, Links
Medication therapy for social phobia.Marshall RD, Schneier FR, Fallon BA, Feerick J, Liebowitz MR.
Anxiety Disorders Clinic, New York State Psychiatric Institute, New York 10032.
Social phobia, though the third most common psychiatric disorder in the United States, has received little systematic attention until recently. Chronic and disabling symptoms usually precede other disorders in individuals with comorbidity, including alcohol abuse. Though about 80% of individuals do not seek treatment, controlled trials have demonstrated efficacy for several medications, of which phenelzine (an irreversible monoamine oxidase inhibitor [MAOI]) is the best studied. The benzodiazepines, clonazepam and alprazolam, also hold promise. New reversible MAOIs such as moclobemide and brofaromine are under investigation; fluoxetine and other serotonin selective reuptake inhibitors need further controlled study. The benefits of group cognitive-behavioral therapy also appear substantial. Issues for future investigation include long-term outcome, differential therapeutics, diagnostic subtyping, and combination treatments.
Publication Types:
Review
Review, TutorialPMID: 8077172 [PubMed - indexed for MEDLINE]
==================================================================================================1: Biol Psychiatry 2002 Jan 1;51(1):109-20 Related Articles, Links
Pharmacotherapy of social anxiety disorder.
Blanco C, Antia SX, Liebowitz MR.
Department of Psychiatry, Columbia College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA.
Over the last few years, a number of medications have demonstrated their efficacy in the acute treatment of social anxiety disorder. At present, selective serotonin reuptake inhibitors probably constitute the first line treatment, based on their safety, tolerability, and efficacy in the treatment of social anxiety disorder and common comorbid conditions. Data from single trials suggest that clonazepam, bromazepam, and gabapentin may have efficacy similar to the serotonin reuptake inhibitors, but further studies are needed to confirm these findings. The monoamine oxidase inhibitor phenelzine appears to be at least as efficacious as these other agents, but should be reserved for cases that fail to respond to these safer medications. Among the reversible inhibitors of monoamine oxidase A, brofaromine may also be an effective drug, while moclobemide appears to be less potent.Future research directions should include delineating ways to achieve remission (as opposed to response); developing strategies for augmenting partial responders and treating nonresponders to first line approaches; studying the long-term response to medication and prevention of relapse when medication is discontinued; clarifying ways to integrate psychosocial and pharmacological treatment approaches; developing predictors of which patients do best with which treatments; and the treatment of social anxiety disorder in children and adolescents.
Publication Types:
Review
Review, TutorialPMID: 11801236 [PubMed - indexed for MEDLINE]
==================================================================================================1: J Clin Psychiatry 1995;56 Suppl 5:18-24 Related Articles, Links
Social phobia: a pharmacologic treatment overview.Jefferson JW.
Dean Foundation for Health, Resarch and Education, Madison, Wis. 53717-1914, USA.
Generalized and specific social phobias are common, chronic, and potentially debilitating conditions. In recent years, there have been major advances in the pharmacotherapy of social phobia; efficacy has become better established for a diverse group of medications. Controlled studies have shown substantial benefit from monamine oxidase inhibitors, both irreversible (phenelzine) and reversible (brofaromine and moclobemide). The serotonin selective reuptake inhibitor antidepressants have shown promise in case reports, uncontrolled studies, and double-blind trials (fluvoxamine and sertraline). The benzodiazepines have been extensively used to treat social phobia, although only recently has a controlled, double-blind study confirmed efficacy (clonazepam). The beta-adrenergic receptor blockers have been widely used on an as needed basis to treat specific social phobia (i.e., performance anxiety), although their value in generalized social phobia has not been convincing. Finally, pharmacologic approaches to social phobia must take into consideration the common coexistence of other psychiatric conditions.
Publication Types:
Review
Review, TutorialPMID: 7782272 [PubMed - indexed for MEDLINE]
==================================================================================================1: J Clin Psychiatry 1994 Jun;55 Suppl:28-32 Related Articles, Links
Treatment of social phobia with benzodiazepines.Davidson JR, Tupler LA, Potts NL.
Anxiety and Traumatic Stress Program, Duke University Medical Center, Durham, N.C. 27710.
Although social phobia is a common and highly treatable anxiety disorder, the majority of social phobics do not receive treatment. Without intervention, it is unlikely that patients will attain significant relief from the symptoms and disability associated with the disease. The authors review the results of studies concerning the use of high-potency benzodiazepines in the treatment of social phobia. These studies, which include open trials as well as a double-blind, placebo-controlled evaluation of clonazepam, have demonstrated clinical efficacy and suggest a therapeutic role for this drug class in the treatment of social phobia. Developmental work with the Davidson Brief Social Phobia Scale is described, along with predictors of treatment outcome for clonazepam and placebo and relapse data upon discontinuation of both treatments. Finally, the authors discuss general issues concerning the relapse of patients upon drug discontinuation, the long-term use of benzodiazepines, and other important issues concerning the use of these agents for the treatment of social phobia.
Publication Types:
Review
Review, TutorialPMID: 8077166 [PubMed - indexed for MEDLINE]
==================================================================================================1: J Clin Psychopharmacol 1993 Dec;13(6):423-8 Related Articles, Links
Treatment of social phobia with clonazepam and placebo.Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH.
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 8120156 [PubMed - indexed for MEDLINE]
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