Posted by benzo85 on October 9, 2010, at 23:56:46
In reply to Re: how do i get my nardil back » benzo85, posted by angels78 on October 9, 2010, at 22:44:00
Things will only get better with time. Past 2 times i've been on Nardil it's taken 5-6mo for it to really kick in and squash symptoms into remission. The first time I took it, it was 5 days. But when it does, it's like everything is fixed.
Paxil COULD work. Works great for some, partially others, not all for others. I'd definitely stick with Nardil and invest the time.
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Therapeutic response to phenelzine in patients with panic disorder and agoraphobia with panic attacks.
Buigues J, Vallejo J.
AbstractThe therapeutic response to phenelzine sulfate was evaluated during 6 months' treatment of 35 outpatients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks. The possible influence of nonspecific predictors of drug efficacy and some biochemical parameters were investigated. Therapeutic response was assessed on standardized rating scales. Agoraphobic patients showed a significantly higher frequency of panic attacks when compared to the subjects with uncomplicated panic disorder. Phenelzine treatment blocked panic attacks in 100% of the patients with panic disorder and in 94.7% of the agoraphobics. Anticipatory anxiety and avoidant behavior improved markedly, although not statistically significantly, in 73.6% of the agoraphobics.
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J Clin Psychiatry. 2005 Jan;66(1):34-40.Efficacy and tolerability of controlled-release paroxetine in the treatment of panic disorder.
Sheehan DV, Burnham DB, Iyengar MK, Perera P; Paxil CR Panic Disorder Study Group.
Institute for Research in Psychiatry, Department of Psychiatry, University of South Florida, Tampa, FL 33613-4788, USA. dsheehan@hsc.usf.edu
AbstractOBJECTIVE: To assess the efficacy and tolerability of controlled-release paroxetine (paroxetine CR) in the treatment of adults with panic disorder.
METHOD: Paroxetine CR (25-75 mg/day; N = 444) was compared with placebo (N = 445) in patients with DSM-IV panic disorder with or without agoraphobia in 3 identical, double-blind, placebo-controlled, 10-week clinical trials that were pooled for analysis.
RESULTS: Paroxetine CR was statistically superior to placebo in the primary outcome measure, percentage of patients who were free of panic attacks in the 2 weeks prior to endpoint. Of the total population that completed or prematurely terminated treatment, 63% and 53% of paroxetine CR-and placebo-treated patients, respectively, were panic-free during the final 2 weeks (p < .005; odds ratio [OR] = 1.63; 95% CI = 1.21 to 2.19). For week 10 completers (72% of total), 73% and 60% of paroxetine CR- and placebo-treated patients, respectively, were panic-free at week 10 (p < .005; OR = 2.11; 95% CI = 1.45 to 3.07). Paroxetine CR was also statistically superior to placebo on the global improvement and severity items of the Clinical Global Impressions scale and in reducing anxiety symptoms as measured by the Hamilton Rating Scale for Anxiety total score and total fear and avoidance on the Marks-Sheehan Phobia Scale. Adverse events leading to study withdrawal were minimal and occurred in 11% of the paroxetine CR group and 6% of the placebo group. Most of the treatment-emergent adverse events were rated as mild to moderate in severity and occurred early in the study. There were no unexpected adverse events, and serious adverse events were uncommon (10 [2.3%] of the 444 patients treated with paroxetine CR vs. 8 [1.8%] of the 445 patients treated with placebo).
CONCLUSION: Paroxetine CR is an effective and well-tolerated treatment for panic disorder. Paroxetine CR is associated with low rates of treatment-emergent anxiety as well as low dropout rates from adverse events.
--------------A randomized controlled trial of venlafaxine ER and paroxetine in the treatment of outpatients with panic disorder.
Pollack M, Mangano R, Entsuah R, Tzanis E, Simon NM, Zhang Y.
Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114-2790, USA. mpollack@partners.org
Erratum in:
* Psychopharmacology (Berl). 2008 Feb;196(2):339. Zhang, Ying [added].
Abstract
RATIONALE: Few randomized, placebo-controlled trials have evaluated the comparative efficacy and tolerability of more than one pharmacological agent for panic disorder.
OBJECTIVES: The primary objective of this study was to compare the efficacy and tolerability of venlafaxine extended release (ER) with placebo in treating panic disorder. Secondary objectives included comparing paroxetine with venlafaxine ER and placebo.
METHODS: Outpatients aged > or =18 years (placebo, n = 157; venlafaxine ER 75 mg, n = 156; venlafaxine ER 225 mg, n = 160; paroxetine, n = 151), with a primary diagnosis of panic disorder (+/-agoraphobia) based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for > or =3 months were randomly assigned to receive venlafaxine ER (titrated to 75 mg/day or 225 mg/day), paroxetine (titrated to 40 mg/day), or placebo for 12 weeks. The primary efficacy measure was the percentage of patients free of full-symptom panic attacks (> or = four symptoms) at endpoint. Key secondary outcomes included the Panic Disorder Severity Scale (PDSS) mean score change and response.
RESULTS: At endpoint, all active treatment groups showed a significantly (P < 0.01) greater proportion of patients free of full-symptom panic attacks, compared with placebo, and were superior (P < 0.05) on most secondary measures. The venlafaxine ER 225 mg group had significantly (P < 0.05) greater mean PDSS score improvement than the paroxetine group (-12.58 vs -11.87) and a significantly higher proportion of patients free of full symptom panic attacks (70.0 vs 58.3%). Both drugs were generally well tolerated.
CONCLUSION: Venlafaxine ER 75 mg/days and 225 mg/days and paroxetine 40 mg/day were both well tolerated and effective for short-term treatment of panic disorder.
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Phenelzine for Treatment-Resistant Panic Disorder
May 7, 2007
David L. Ginsberg, MD
Vice-Chair, Clinical Services, Department of Psychiatry, NYU Medical Center
The only medications currently FDA approved for panic disorder are fluoxetine, sertraline, paroxetine, venlafaxine, alprazolam, and clonazepam. Some data exists, however, demonstrating the efficacy of phenelzine for panic disorder and phobic anxiety. Now comes the first published report of the successful use of phenelzine for severe, treatment-resistant panic disorder with agoraphobia.
The CaseA 45 year-old computer engineer with poorly controlled panic disorder presented for outpatient treatment in 2005 complaining of 2 panic attacks per day, each characterized by the sudden onset of extreme anxiety, diaphoresis, derealization, abdominal distress, and fear of losing control. The symptoms peaked 15 minutes after onset and lasted one hour, with residual anxiety lasting most of the day. His panic attacks had started 5 years earlier and had been at the presenting severity level for 2 years. He denied use of alcohol, coffee, tobacco, illegal drugs, or of any other anxiogenic herbal or over-the-counter products. At the time of presentation, his medication regimen consisted of paroxetine 20 mg qAM, mirtazapine 30 mg qHS, clonazepam 1 mg bid, alprazolam 1 mg qid, and metoprolol XL 200 mg qD, prescribed for hypertension.
After the initial evaluation, mirtazapine was discontinued and the dose of paroxetine was increased to 60 mg qD for the next 6 weeks. The patient learned deep-breathing exercises. While alprazolam was discontinued, clonazepam was increased, to 1 mg qid. Subsequently, the patients panic and general anxiety symptoms significantly worsened. Eventually, he was placed on alprazolam 1 mg qid, clonazepam 1 mg tid, and gabapentin 1,200 mg tid, which brought him back to a relative baseline of minimal functioning. Paroxetine was then tapered as follows: 40 mg/day for 7 days then 20 mg/day for 7 days then discontinuation. Two weeks after the last dose of paroxetine, phenelzine 15 mg/day was initiated, then increased over 9 days to a target dose of 15 mg qid.
Within 4 days of treatment with phenelzine 15 mg qid, the patients panic attack frequency decreased to one panic attack every other day, the lowest rate he had experienced in 2 years. Subsequently, the panic attacks continued to diminish. At last follow-up, the patient reported being free of panic attacks for the prior 2 months, his longest period of sustained remission. He also denied experiencing any symptoms of agoraphobia. He continued to take, in addition to phenelzine 15 mg qid, alprazolam 0.25 mg qHS, clonazepam 0.5 mg qAM, and gabapentin 1,200 mg tid.
ConclusionThe case reported here suggests that phenelzine may be a useful medication for treatment-resistant or treatment-refractory panic disorder. As was true for the patient described, adjunctive medication, and psychotherapy, may also be required to achieve full remission.
poster:benzo85
thread:965020
URL: http://www.dr-bob.org/babble/20101009/msgs/965220.html