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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by John on March 28, 1999, at 7:42:02
Does anyone know of new medications being used to treat Social Phobia. Also can soneone recommend a Doctor in the Northern Va. and D.C. area who specializes in this kind of treatment?
Posted by Matt on March 28, 1999, at 23:35:42
In reply to New Medications for Social Phobia, posted by John on March 28, 1999, at 7:42:02
> Does anyone know of new medications being used to treat Social Phobia. Also can soneone recommend a Doctor in the Northern Va. and D.C. area who specializes in this kind of treatment?
What do you mean by "new?" You mean newer than the SSRIs?Matt
Posted by melelani on April 3, 1999, at 1:04:29
In reply to Re: New Medications for Social Phobia, posted by Matt on March 28, 1999, at 23:35:42
> > Does anyone know of new medications being used to treat Social Phobia. Also can soneone recommend a Doctor in the Northern Va. and D.C. area who specializes in this kind of treatment?
>
>
> What do you mean by "new?" You mean newer than the SSRIs?
>
> Matt
Posted by Victoria on April 4, 1999, at 19:33:53
In reply to New Medications for Social Phobia, posted by John on March 28, 1999, at 7:42:02
I read some reports in the newspaper a couple of months ago about a study which documented the effectiveness of Paxil for social phobia. I don't remember where the study was done. A good bet for finding a doc who's up on latest research is the psychiatry or psychopharmacology dept. at a university medical school.
> Does anyone know of new medications being used to treat Social Phobia. Also can soneone recommend a Doctor in the Northern Va. and D.C. area who specializes in this kind of treatment?
Posted by Terry on April 4, 1999, at 20:11:58
In reply to New Medications for Social Phobia, posted by John on March 28, 1999, at 7:42:02
There was a study in JAMA (Journal of the American Medical Association), 280:708-713 (I think that was around August or Sept. of 98) indicating that Paxil (paroxetine) was effective against social phobia. Patients in the Paxil study received up to 50 mg daily with significant improvements on scales such as Clinical Global IMprovement (CGI). Other SSRIs (including Luvox) tend to be used interchangeably for this condition. Terry
> Does anyone know of new medications being used to treat Social Phobia. Also can soneone recommend a Doctor in the Northern Va. and D.C. area who specializes in this kind of treatment?
Posted by Elizabeth on April 6, 1999, at 1:07:58
In reply to Re: New Medications for Social Phobia, posted by Terry on April 4, 1999, at 20:11:58
Paxil worked, according to one study.
This is not saying much compared with the abundant evidence that Nardil, an older drug, works far more often than Paxil did in this study! However, Paxil - or any of the other SSRIs (e.g., Prozac, Luvox) - might be a better first choice since they have fewer side effects (usually). Tricyclics do not work.
Benzodiazepines - Klonopin and Xanax have been studied, Ativan and (probably) others would work too - are another option.
If you find at least two SSRIs and two benzos don't help (with adequate trials), I'd say Nardil (or another MAO inhibitor) is probably the best option, though others may disagree. There just isn't much compelling evidence to support the use of anything else.
I'm not sure where you would go to find a good doctor in your area, but I tend to think that the best places to look are university-affiliated hospitals. (Ask for a specialist in anxiety disorders.)
Good luck! :-)
Posted by Terry on April 6, 1999, at 10:49:57
In reply to Re: New Medications for Social Phobia, posted by Elizabeth on April 6, 1999, at 1:07:58
Elizabeth -- I would think that MAOIs like Nardil wouldn't be used first-line anymore for social phobia (or any other indication, for that matter) because of the many interactions with other drugs and foods associated with them. My understanding was that because of those side effects, most docs now prefer to use MAOIs second- or third-line for depression and other indications. I know when I read throught the list of interactions for Nardil, I thought there was no way I'd take it, even if it was the most effective drug in the world. Also, why would you take a benzodiazepine for social phobia? I wasn't aware there were studies of those drugs for that indication, or were they done long ago before the SSRIs? Terry
> Paxil worked, according to one study.
>
> This is not saying much compared with the abundant evidence that Nardil, an older drug, works far more often than Paxil did in this study! However, Paxil - or any of the other SSRIs (e.g., Prozac, Luvox) - might be a better first choice since they have fewer side effects (usually). Tricyclics do not work.
>
> Benzodiazepines - Klonopin and Xanax have been studied, Ativan and (probably) others would work too - are another option.
>
> If you find at least two SSRIs and two benzos don't help (with adequate trials), I'd say Nardil (or another MAO inhibitor) is probably the best option, though others may disagree. There just isn't much compelling evidence to support the use of anything else.
>
> I'm not sure where you would go to find a good doctor in your area, but I tend to think that the best places to look are university-affiliated hospitals. (Ask for a specialist in anxiety disorders.)
>
> Good luck! :-)
Posted by JohnB. on April 10, 1999, at 1:08:53
In reply to New Medications for Social Phobia, posted by John on March 28, 1999, at 7:42:02
> Does anyone know of new medications being used to treat Social Phobia. Also can soneone recommend a Doctor in the Northern Va. and D.C. area who specializes in this kind of treatment?
John:
I know of no specific new drugs for Social Phobia, but lots of work is being done with existing meds, particularly those affecting the dopamine receptors in the brain. There seems to be a link between social isolation/withdrawal and inadequate dopamine function. Since the MAOI's have the best clinical record for effectiveness in treating Social Phobia, there's a good likelihood that since MAOI's potentiate all the big three neurotransmitters and since serotonin and norepinepherine meds abound with mixed results on SPhobia, dopamine seems solidly implicated. Stimulants enhance dopamine levels, but seem to contribute to anxiety/discomfort levels. Look to some of the European meds being studied; they don't seem to be afraid to deal with dopamine enhancing drugs like U.S. researchers are. It's almost as if concentrating on the core pleasure/reward circuits of the brain is forbidden territory, as if uncovering the neural circuits involved in calmness, self-satisfaction, gregariousness, inner peace and feelings of pleasure might actually lead to a totally effective treatment for that inner pain that never leaves!
Anyway, do a Net search for Social Phobia, check out Medline for studies, look up Dr. Jonathan Davidson (THE authority) on the Web or at the Library (his office is at my PSYCH's practice in Raleigh, NC -- also adjunct prof. at Duke U.) And explore dopamine studies. You'll be fascinated.Good luck. Let me know how things go.
Posted by Elizabeth on April 12, 1999, at 5:16:51
In reply to Re: New Medications for Social Phobia, posted by Terry on April 6, 1999, at 10:49:57
Well, first of all I didn't say they should be first-line treatment; I said I think it is worthwhile to try SSRIs and high-potency benzodiazepines first. (In regards to the use of benzodiazepines, see Davidson et al "Treatment of SP with Clonazepam and Placebo" (1993), for example.)
A lot of people have this attitude, which is unfortunate. It turns out that a lot of the supposed interactions don't actually occur experimentally. Many of the food items listed as "restricted" on various MAOI diets are there as a result of isolated and poorly-documented case reports. Shulman and colleagues (1989, 1996, 1997, 1999) have done some long-overdue research in this area and made recommendations for a simplified diet based on actual tyramine (and dopa) levels in foods and on well-documented case reports. (A medline search for "Shulman KI" should give you the abstracts.)
By the way, I've taken MAOIs (following Shulman's dietary recommendations). The only thing I found annoying to have to avoid was Sudafed.
This is the end of the thread.
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