Posted by Michael Bell on January 23, 2005, at 9:04:01
In reply to Re: Restarting Nardil = never effective again?, posted by jasmineneroli on January 23, 2005, at 2:05:35
>
I try not to get political about meds, but first things first, FIND A NEW DOCTOR FOR YOUR DAUGHTER!! Assuming that you have that option, of course. Look, if Social Phobia is your daughter's primary problem, SSRIs are NOT the right med for her, especially as monotherapy. I've said it before and I'll say it a million times, SEROTONIN DEFICIENCY IS NOT THE MAIN CAUSE, OR EVEN A MAJOR CAUSE, OF SOCIAL PHOBIA. If anything, the serotonin receptors are hypersensitive. The only reason SSRIs considered the "first line of treatment" by some docs is because SSRIs are a multibillion dollar industry. These drugs were developed to fight depression, and the manufacturers push to extend the label to cover other disorders in order to make more money. For anxiety, the only reasons SSRIs may work is because they cause INCREASED anxiety in the first couple weeks, then the receptors become desensitized. In other words, the brain becomes numb past the point of any feeling at all, let alone anxiety. (Disclaimer: Klono + SSRI can, however, be a very effective combo for some. If you do come across an SSRI that really helps your daughter, then obviously go with it). However, a truly informed doctor, especially one who specializes in anxiety, will prescribe Klonopin as the first line of treatment without a second thought.GABA. GABA. GABA. GABA. GABA. And again, GABA. Your daughter needs a drug that effects GABA. GABA disfunction is the primary cause of social phobia. Period. The most effect drugs (legal and illegal) for SP all have profound and primary effects on the GABA system. Klonopin, Xanax, Ativan, Xyrem, Alcohol, Nardil. You said your daughter found amazing relief from the Klono you sent her. Proof positive. Yes, other transmitters are probably involved to some degree (CCK for example, dopamine transmission in the amygdala as well), but GABA is the main culprit!
Sorry for that little rant. And thanks for the good luck wishes regarding the surgery. Now to answer your questions. Regarding the Klonopin + Adderall + Tianeptine combo, here's why I stopped it:
1) Klonopin: It is extremely effective for social anxiety. Nothing compares (except maybe Nardil). Especially useful for the physical symptoms, but it does help for the phobic thought processes as well. I'M STILL ON SMALL DOSES OF KLONO (.5 mg/day). I would definitely recommend this as the first line of treatment for social phobia. For people who have Social Phobia (or possibly GAD) as their only diagnosis, I say stay away from SSRIs and try to get a benzo, especially Klonopin
2) Tianeptine: has some anxiolytic activity, but the effects are fleeting and inconsistent. Some days seemed to work, others it did not. Too expensive in light of the questionable effectiveness.
3) Adderall: I do NOT recommend this drug unless your child has been diagnosed with ADHD. It is certainly NOT good for social phobia as monotherapy, it causes hyperfocusing, social withdrawal. Moreover, it increases CCK release, and CCK is bad for anxiety. If it does cause euphoria, it is very short lived. Medication should NOT cause continuous euphoria, as this is not a natural state. In combination with Klonopin, it sometimes had a prosocial effect, but this was very infrequent.
So why did I start Nardil? Because although Klonopin is great for SP, it is has been known to cause depression in many people after long term use. Not the "I want to throw myself off a cliff" kind of depression, but more of a low-grade dysthymia/anhedonia. Yes it kills anxiety, but for me it also reduced the ability to feel pleasure and gave me a flattened affect. Still I recommend giving it a try, as some people may not develop this low grade depression. Nardil fixes this problem for me.
My current combo is Nardil + Klonopin.
Good luck on whatever decision you make.
Hi Michael:
> Good luck with the surgery!
> I have just been doing an archive search on Tianeptine and read some of your posts on a combo that included Klonopin, Tianeptine & occasional Adderall.
> Two questions:
> 1)Presumably, since you are now taking Nardil, that combo wasn't as effective as hoped. Can you tell me what happened?
> I have GAD and already take Klonopin, was interested in adding Tianeptine.
>
> 2)My daughter, however, has pretty severe Social Anxiety and Anhedonia (which is probably part of the SA, rather than depression). Also, possible GAD & ADD. You seem to have very similar symptomology to her.
> She lives in another city and her doc insists on Celexa only, won't give her Klonopin. She is so debilitated, she finds working a torture. She also isolates herself at home - socially withdrawn. I've sent her some of my Klon. and she's found amazing relief, it makes her able to go to work!
> Would you now recommend Nardil only, for her situation? Or did the previous combo, give relief too?
>
> Feeling a bit helpless and wanting to provide suggestions for my daughter's doc. Thanks for your time.
> Jas
poster:Michael Bell
thread:444453
URL: http://www.dr-bob.org/babble/20050119/msgs/446140.html