Posted by scott-d-o on February 20, 2004, at 3:48:01
In reply to Re: Distinguishing the SSRI's . . . what do you think?, posted by krybrahaha on February 19, 2004, at 23:32:17
> > My p-doc, who is also a pharmacologist, tells me that SSRI all have the same "primary effect," in that if one will work, they all should work. BUT, he says, the difference is in the "side effects." I.e., Sexual sides, insomnia, initial anxiety etc...
> > I asked him this, because I was trying to determine what the "best" SSRI is for SAD. He said that "if" SSRI's work for me, the right one will be the one leaves me with the least amount of unwanted side effects, and that no one specific SSRI will be "better" for treating SAD than any other. (Aside maybe from Prozac which has the "side effect" of making some people more anxious apparently).
> >
> > What do you all think of this theory?
> > I don't question his wisdom, I just like to hear about other peoples experiences and thoughts.
> >
> >
> I was told completlely the opposite by my p-doc who is also a neurologist. He says that each SSRI is different in a way they affect different chemicals. They dont just affect serotonin. Zoloft messes with dopamine a little, others mess with norepinephrine - i asked him several times about this because I have taken every SSRI and have always wondered why Luvox worked for my SAD, GAD , and OCD and the others didnt know nothing whatsoever. It all depends on body chemistry as well
>this is true, they all differ slightly in their selectivity for the serotonin transporter. lexapro (escitalopram) and celexa (which is just racemic citalopram) are the most selective for this transporter. However, the differences in selectivity between the AD's is so minute that one wonders if there could possibly be any difference in efficacy in practice. However, some SSRI's do have some additional effects such as Paxil which is somewhat anticholinergic.
as to the original question, I believe none of the ssri's are effective for a patient that is properly diagnosed with SAD. they can reduce the anxious tendencies which are a manifestation of a depressive disorder, however. For instance, individuals that are depressed are probably more likely to be anxious during social interactions due to, for instance, low self-esteem. social anxiety disorder usually manifests itself around adolescence and these individuals have been social outcasts for most of their lives.
anyhow, if you think you do have this anxiety disorder the most effective meds by far are klonopin and nardil. stimulants also help many but can cause anxiety as well. I find the combination of klonopin and a stimulant (adderall) works well for me. basically, dopamine and gaba are the two neurotransmitters you want to look into. nardil is a maoi that effects both of these by indirectly increasing gaba in addition to inhibiting monoamine oxidase which is resposible for the breakdown of all the monoamines (5-ht,da,ne). klonopin is gabanergic and arguably the most effective "pure" anti-anxiety med. the stimulants also increase all the monoamines (mostly just da/ne) except by a different mechanism than maoi's (reuptake inhibition and/or release vs. monoamine oxidase inhibition).
another med which is helpful for SAD is amisulpride or sulpiride which cause da release at low doses. unfortunetly, it's not available in the usa. I also had good results with the amisulpride/klonopin combo. I've never tried nardil simply because of the dietary restrictions, but would not hesitate to do so if nothing else worked.
hope this helps
scott
poster:scott-d-o
thread:315485
URL: http://www.dr-bob.org/babble/20040218/msgs/315964.html