![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Cynthia on September 10, 1999, at 20:14:29
HI,
I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS, NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100% ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT WORKED BETTER THAN NARDIL, WITHOUT THE SIDE EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE RELEASED IN THE US (4TH QTR 1999). ALSO, UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE IT THROUGH STAGE III TRIALS DUE TO LACK OF EFFICACY.
THERE HAS TO BE SOMETHING! BY THE WAY, PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
ANY IDEAS?????????????????
Posted by Douglas on September 11, 1999, at 8:52:49
In reply to SOCIAL PHOBIA: ANYTHING BETTER THAN NARDIL?, posted by Cynthia on September 10, 1999, at 20:14:29
> HI,
>
> I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS, NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100% ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT WORKED BETTER THAN NARDIL, WITHOUT THE SIDE EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE RELEASED IN THE US (4TH QTR 1999). ALSO, UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE IT THROUGH STAGE III TRIALS DUE TO LACK OF EFFICACY.
>
> THERE HAS TO BE SOMETHING! BY THE WAY, PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
>
> ANY IDEAS?????????????????
Hi,
Sorry no good news, but I can save you some time. I also have social phobia. I have had success with Xanax before events I assume may induce a social anxiety attack. To help in the times when I couldn't anticipate, I tried paxil and selexa, but discontinued their use because of anorgasmia. There was no decrease in libido, but the anorgasmia was too frustrating to live with. I am supposed to be trying luvox now, but I haven't started it because I want a normal sex life for a while. I'll probably try it soon, but I have pretty much come to the conclusion that the ssri's are going to cause sexual side effects in men and probably women too. Anorgasmia is almost always connected to the ssri in a man taking it with no history of anorgasmia before. Sorry to ramble, but I have had these thoughts on my mind for a while. I think the inserts that come with the ssri's showing around a 7% occurrence of anorgasmia are totally false. I suspect they don't want to change them because it would hurt their bottom line. Maybe part of the reason for the 7% figure is that people are having none or very little sex while participating in the drug trials. I would like to here from anyone especially men taking ssri's (paxil,luxox,celexa, etc.) who had no sexual side effects. I bet there just aren't many out there.
Thanks for letting me vent.
Posted by Rick on September 11, 1999, at 19:13:21
In reply to SOCIAL PHOBIA: ANYTHING BETTER THAN NARDIL?, posted by Cynthia on September 10, 1999, at 20:14:29
> HI,
>
> I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS, NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100% ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT WORKED BETTER THAN NARDIL, WITHOUT THE SIDE EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE RELEASED IN THE US (4TH QTR 1999). ALSO, UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE IT THROUGH STAGE III TRIALS DUE TO LACK OF EFFICACY.
>
> THERE HAS TO BE SOMETHING! BY THE WAY, PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
>
> ANY IDEAS?????????????????I'm having MUCH better and more consistent results with Klonopin (alone) than I did with Nardil (which I used both alone and with various potentiators -- NOT including Klonopin). I feel relaxed and notice improved cognition, perhaps because the release of anxiety allows me to focus more. While I had terrible side effects with Nardil, like complete inability to achieve orgasm, the ONLY negative side effect with Klonopin has been occasional, short-lived drowsiness. I've found that the drowsiness has abated somewhat over time, especially as I've experimented with timing of the doses (I take 1.5-2.5 mg total most days). Surprisingly, Klonopin consistently ENHANCES sex for me.
By the way, I am also taking a very low dose of Pindolol, a rather weak, non-selective beta blocker for mild hypertension. My pdoc suggested it (vs. other anti-hypertensives) for its reputed seratonergenic (sp?) effects. It is often used to potentiate and "speed up" AD's (especially SSRI's), but my guess is that it does NOT potentiate the Klonopin -- just possibly causes more fatigue. Of course, non-selective beta blockers (usually Propanalol) are sometimes prescribed for "performance anxiety"-specific social phobia, so who knows??
Posted by Elizabeth on September 15, 1999, at 2:14:56
In reply to Re: SOCIAL PHOBIA: ANYTHING BETTER THAN NARDIL?, posted by Rick on September 11, 1999, at 19:13:21
If you haven't been taking the Klonopin for long, give it a chance: the drowsiness is a side effect that may go away with time. (If it doesn't, try switching to another benzodiazepine such as Ativan or Xanax.) What dose are you on?
I'm not sure why you say Parnate's efficacy is "equivocal." There isn't much evidence supporting it (just because SP wasn't recognized as a separate disorder in Parnate's heyday - older studies of MAOIs in phobic disorders tend to mix together patients with agoraphobia, social phobia, etc.), but I don't know of any evidence at all *against* it. Parnate does not cause weight gain and, for me at least, doesn't cause sexual dysfunction either.
Marplan (isocarboxazid), a second hydrazine-type MAOI, may be an option. It does seem to cause weight gain for some people, though. I think an SSRI (or Effexor or Serzone) is worth at least a try, as well. Another thought would be Buspar (although that one really is equivocal - be willing to try high doses or use it with an SSRI and/or pindolol). You mentioned Neurontin (gabapentin) as well; that might be worth trying. It tends to be somewhat sedating (at least, at first) but otherwise has few side effects. Gabitril (tiagabine) is another anticonvulsant that might be worth a shot.
Tricyclic antidepressants aren't seen as being helpful in SP. Reboxetine might well turn out to work, but I doubt it would.
Posted by Rick on September 15, 1999, at 15:01:23
In reply to alternatives to Nardil, posted by Elizabeth on September 15, 1999, at 2:14:56
Elizabeth--
MY current sedation from Klonopin isn't a major problem, but it's still strong enough to be a bit of a bother, and detracts somewhat from the drug's relief of my most troublesome Social Phobia symptom (tremulous voice in certain meetings/presentations/center-of-attention situations/phone or at-the-counter discussions with strangers -- especially one-on-ones "authority figures" (!!) like operators or clerks -- and most especially if there's some contentious situation involved).
How long a "chance" does the sedation need to go away? I've been at 1.5-3.0 mg of Klonoin per day for almost 2 months, ususally 1.5-2.5. No other meds except just 5mg Pindolol in the morning. I don't want to take either med after dinner, because they could worsen whatever severe sleep apnea I have remaining afetr losing 40-50 pounds. I know this would only worsen nervous reactions (not to mention being a detriment to my health).
Thanks,
Rick
-----
> If you haven't been taking the Klonopin for long, give it a chance: the drowsiness is a side effect that may go away with time. (If it doesn't, try switching to another benzodiazepine such as Ativan or Xanax.) What dose are you on?
>
> I'm not sure why you say Parnate's efficacy is "equivocal." There isn't much evidence supporting it (just because SP wasn't recognized as a separate disorder in Parnate's heyday - older studies of MAOIs in phobic disorders tend to mix together patients with agoraphobia, social phobia, etc.), but I don't know of any evidence at all *against* it. Parnate does not cause weight gain and, for me at least, doesn't cause sexual dysfunction either.
>
> Marplan (isocarboxazid), a second hydrazine-type MAOI, may be an option. It does seem to cause weight gain for some people, though. I think an SSRI (or Effexor or Serzone) is worth at least a try, as well. Another thought would be Buspar (although that one really is equivocal - be willing to try high doses or use it with an SSRI and/or pindolol). You mentioned Neurontin (gabapentin) as well; that might be worth trying. It tends to be somewhat sedating (at least, at first) but otherwise has few side effects. Gabitril (tiagabine) is another anticonvulsant that might be worth a shot.
>
> Tricyclic antidepressants aren't seen as being helpful in SP. Reboxetine might well turn out to work, but I doubt it would.
Posted by GS on September 16, 1999, at 0:46:35
In reply to SOCIAL PHOBIA: ANYTHING BETTER THAN NARDIL?, posted by Cynthia on September 10, 1999, at 20:14:29
> HI,
>
> I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS, NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100% ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT WORKED BETTER THAN NARDIL, WITHOUT THE SIDE EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE RELEASED IN THE US (4TH QTR 1999). ALSO, UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE IT THROUGH STAGE III TRIALS DUE TO LACK OF EFFICACY.
>
> THERE HAS TO BE SOMETHING! BY THE WAY, PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
>
> ANY IDEAS?????????????????
**************************************************Yes - benzodiazapines of the shorter half life variety like ativan (instead of the longest half life type like klonopin) work well for social phobias. If you don't have a personality prone to addictive substances there should be no problem. If you take a comfortable dosage that provides you relief and if you then experience any withdrawl when the ativan fluctuates to varying degrees in and out of the system, augment with a low dose of the low side effect profile mood stabilzer Gabapentin. This will mediate any drug induced anxiety. This works well for me anyway. Bezodiazapines are not "addictive" by nature despite what some under-informed docs state (most of the highest skilled docs agree with prescribing benzos long term for treating anxiety disorders - if properly managed). If one has an anxiety disorder they should be treated with an anti-anxiety medicine! At least until medical science comes up with something better.
Sure, if you stop taking benzos there would be a period of withdrawl - minimized of course by tapering very gradually - but the alternative which is suffering with chronic anxiety is by far the worst choice. An undertreated case of anxiety is one of the closest things to hell on earth that can be imagined. I know from experience. I have the same problem as you and now I am a highly functioning individual - not worrying needlessly with the fear of the fear of anxiety so to speak - nor the fear that I'll become "addicted" to benzos.
Read the thread on Benzodiazapines if you want to find out more....
GS
***********************************************
Posted by Carmen on September 18, 1999, at 19:41:57
In reply to Re: SOCIAL PHOBIA: ANYTHING BETTER THAN NARDIL?, posted by GS on September 16, 1999, at 0:46:35
> > HI,
> >
> > I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS, NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100% ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT WORKED BETTER THAN NARDIL, WITHOUT THE SIDE EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE RELEASED IN THE US (4TH QTR 1999). ALSO, UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE IT THROUGH STAGE III TRIALS DUE TO LACK OF EFFICACY.
> >
> > THERE HAS TO BE SOMETHING! BY THE WAY, PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
> >
> > ANY IDEAS?????????????????
> **************************************************
>
> Yes - benzodiazapines of the shorter half life variety like ativan (instead of the longest half life type like klonopin) work well for social phobias. If you don't have a personality prone to addictive substances there should be no problem. If you take a comfortable dosage that provides you relief and if you then experience any withdrawl when the ativan fluctuates to varying degrees in and out of the system, augment with a low dose of the low side effect profile mood stabilzer Gabapentin. This will mediate any drug induced anxiety. This works well for me anyway. Bezodiazapines are not "addictive" by nature despite what some under-informed docs state (most of the highest skilled docs agree with prescribing benzos long term for treating anxiety disorders - if properly managed). If one has an anxiety disorder they should be treated with an anti-anxiety medicine! At least until medical science comes up with something better.
>
> Sure, if you stop taking benzos there would be a period of withdrawl - minimized of course by tapering very gradually - but the alternative which is suffering with chronic anxiety is by far the worst choice. An undertreated case of anxiety is one of the closest things to hell on earth that can be imagined. I know from experience. I have the same problem as you and now I am a highly functioning individual - not worrying needlessly with the fear of the fear of anxiety so to speak - nor the fear that I'll become "addicted" to benzos.
>
> Read the thread on Benzodiazapines if you want to find out more....
>
> GS
> ***********************************************
GS, Hi! I too have social phobia which I have battled w/for years. As of August of this year they have been recommending Neurontin for this. It has minimal side affects. I'm very sensitive to meds, but it has worked wonders for me. I also use Clonopin as needed. I'm so far taking 300mg Neurontin per day. Went on my first job interview in years last week ( and got the job by the way) and I really felt in control of my emotions and anxiety. The most my Dr. likes to prescribe is 1800mg. but you can go higher. Takes a week or so to notice improvement. Hope this helps you. Talk to your Dr. Like I said before, it's just been released for this problem. Carmen This is for Cynthia - excuse me.
Posted by Elizabeth on September 19, 1999, at 5:52:21
In reply to Re: alternatives to Nardil, posted by Rick on September 15, 1999, at 15:01:23
> MY current sedation from Klonopin isn't a major problem, but it's still strong enough to be a bit of a bother, and detracts somewhat from the drug's relief of my most troublesome Social Phobia symptom (tremulous voice in certain meetings/presentations/center-of-attention situations/phone or at-the-counter discussions with strangers -- especially one-on-ones "authority figures" (!!) like operators or clerks -- and most especially if there's some contentious situation involved).
It might be helpful to take a small amount of extra pindolol (2.5-5 mg? not sure; it would be 10-20 mg of propranolol if you were using that) before nerve-wracking situations (such as presentations and one-on-ones) to help with tremulousness in your voice.
> How long a "chance" does the sedation need to go away? I've been at 1.5-3.0 mg of Klonoin per day for almost 2 months, ususally 1.5-2.5.
What dosing schedule? Dividing it up more may decrease the side effects, including sedation (i.e., if you're taking it just twice a day, try splitting the same amount in three - for example, if you took 1mg in the AM and 1mg in the PM, you might switch to 0.5mg AM, 0.5mg afternoon, and 1mg at bedtime).
>No other meds except just 5mg Pindolol in the morning. I don't want to take either med after dinner, because they could worsen whatever severe sleep apnea I have remaining afetr losing 40-50 pounds. I know this would only worsen nervous reactions (not to mention being a detriment to my health).
Very wise! Sleep apnea is something serious and not to be messed with, IMHO.
Posted by Rick on September 19, 1999, at 11:44:44
In reply to Re: alternatives to Nardil: Rick, posted by Elizabeth on September 19, 1999, at 5:52:21
> > MY current sedation from Klonopin isn't a major problem, but it's still strong enough to be a bit of a bother, and detracts somewhat from the drug's relief of my most troublesome Social Phobia symptom (tremulous voice in certain meetings/presentations/center-of-attention situations/phone or at-the-counter discussions with strangers -- especially one-on-ones "authority figures" (!!) like operators or clerks -- and most especially if there's some contentious situation involved).
>
> It might be helpful to take a small amount of extra pindolol (2.5-5 mg? not sure; it would be 10-20 mg of propranolol if you were using that) before nerve-wracking situations (such as presentations and one-on-ones) to help with tremulousness in your voice.
>
> > How long a "chance" does the sedation need to go away? I've been at 1.5-3.0 mg of Klonoin per day for almost 2 months, ususally 1.5-2.5.
>
> What dosing schedule? Dividing it up more may decrease the side effects, including sedation (i.e., if you're taking it just twice a day, try splitting the same amount in three - for example, if you took 1mg in the AM and 1mg in the PM, you might switch to 0.5mg AM, 0.5mg afternoon, and 1mg at bedtime).
>
> >No other meds except just 5mg Pindolol in the morning. I don't want to take either med after dinner, because they could worsen whatever severe sleep apnea I have remaining afetr losing 40-50 pounds. I know this would only worsen nervous reactions (not to mention being a detriment to my health).
>
> Very wise! Sleep apnea is something serious and not to be messed with, IMHO.---------
Thanks for the ideas, Elizabeth.Interestingly I find the Klonopin least sedating first thing in the morning, so I take 1 mg when I get up, along with my 5 mg daily Pindolol dose. (I don't want to take Pindolol too late either, because non-selective beta blockers can also interfere with sleep and thus worsen apnea.) Since I handle it well early, I might try upping the initial Klonopin to 1.5 to see if I can take less later. I've already tried 2.0 first thing, but that was sedating. After the initial dose, I spread the remainder of my daily 1.5-3.0 dosage over the rest of the WORKING day (usually in .5 increments), with a special eye towards dosing a bit before an anticipated stressful situation.
The problem is that I can relapse a bit in the evenings with this approach. Yesterday I saw my pdoc, and he wants me to try compensating for the no-Klonopin-at-night self-restriction by adding Buspar -- 15 mg, all at dinner. He said that, after awhile, this might help with evening social phobia episodes.
Now, I did a little (oh, just 5 hours) of net research last night, and found that most trials have found Buspar completely ineffective for SP. On the other hand, I might have mild GAD (which is Buspar's official indication), and I KNOW I have mild OCD (Buspar has been said to be a good potentiator for AD's in treating OCD).
Most interestingly, however, I found a 1997 Medline abstract that actually concluded the SSRI potentiators Buspar + Pindolol ALONE (i.e. WITHOUT an AD) acted as a more effective, and much quicker acting, antidepressant than Buspar + Luvox -- 50% significant response to severe depression in one week! (Reply if you'd like me to send or post a copy of the abstract. The authors' explanations of the possible underlying mechanisms is fascinating, once i was able to digest it). So, in an attempt to take advantage of this discovery, I've decided to take half (i.e., 7.5 mg) of the Buspar in the morning along with the usual 1 mg Klonopin, at the same time I take the Pindodol instead of 12 hours later (when I will take the remaining 7.5 Buspar). I'll try this for at least the first week.
Maybe this will turn out to be a bust, or maybe it will be a good move? Who knows? Frankly, my main concern is that I don't want to somehow "screw up" the tremendous (75+%?) relief I've gotten from th Klonopin (+ Pindolol) thus far. For my first dose of Buspar, I *did* take it as described, and felt some of those mild dizziness/lightheadness feelings that I got from Nardil just before it pooped out. So I started worrying (irrationally, no doubt) about un-doing the good that's been done. I'm just now entering a period where I've got a big slew of SP challenges (especially presentations and meetings) coming up, so I was hoping to be nearly past the experimentation stage. Indeed, I almost decided not to even try the Buspar until I saw how te first big challenges went. Hey, maybe that continual worrying means I *do* have some degree of GAD, ergo, Buspar could be helpful!
BTW, does anyone have real-life experience with Buspar+Klonopin, or Buspar+Klonopin+Pindolol (I'm probably #1 on THAT odd cocktail). I'm particularly interested in hearing from anyone with Social Phobia. Be sure to mention all of the mental disorders you deal with, since that would make a big difference in how your situation on these meds could predict possible reactions for me.
Posted by Rick on September 20, 1999, at 3:31:03
In reply to SOCIAL PHOBIA: ANYTHING BETTER THAN NARDIL?, posted by Cynthia on September 10, 1999, at 20:14:29
> HI,
>
> I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS
PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY
EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE
PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M
TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS,
NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF
KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO
GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100%
ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT
WORKED BETTER THAN NARDIL, WITHOUT THE SIDE
EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE
SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER
THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED
WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE
SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL
DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY
COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER
ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL
PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT
REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE
RELEASED IN THE US (4TH QTR 1999). ALSO,
UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE
IT THROUGH STAGE III TRIALS DUE TO LACK OF
EFFICACY.
>
> THERE HAS TO BE SOMETHING! BY THE WAY,
PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
>
> ANY IDEAS?????????????????--------
Contrary to initial reports, the reversible,
A-selective, and thus "gentle" (no food
restrictions or nasty side effects) MAOI
Moclobemide has recently been shown to be fairly
ineffective for Social Phobia. Yet tests as
recent as 1997 by Ciba-Geigy show Brofaromine,
another reversible, A-selective gentle MAOI to be
VERY effective for SP (e.g., see Medline 1997
study).So why isn't Brofaromide being manufactured
anymore?? At least Moclobemide (Manerix) can be
bought in Canada or mail-ordered to the U.S., but
why wouldn't Ciba withold Brofaromide just as
Social Phobia/Anxiety is finally being recognized
as a HUGELY prevalent mental disorder, and
garnering scads of press...not to mention the
drug's base use as an AD. Is someone asleep at
the wheel and denying the Social Phobics and MAOI
that actually works AND won't make them give up
cheese or sex? What gives? Geez, someone can
make MONEY from this, no??
Posted by JohnL on September 20, 1999, at 5:07:10
In reply to Re: alternatives to Nardil: Elizabeth, posted by Rick on September 19, 1999, at 11:44:44
I am familiar with the Pindolol+Buspar thing. For a cool presentation of that plus some other related stuff, go to http://www.med.nyu.edu/Psych/aug/index.htmIt is a presentation by NYU. You can choose either text or graphic. Both are cool. It discusses that Pindolol+Buspar study and shows a graphic illustration of how it theoretically works and also the results of the study. I tried the combo for a week but found the confusion, weakness, dizziness too much at the time. I didn't have the heart to continue, but I should have. I was trying to duplicate the study, but in hindsight I should have started at lower doses.
Anyway, check it out.
Posted by Rick on September 20, 1999, at 10:12:36
In reply to Re: alternatives to Nardil: Rick, posted by JohnL on September 20, 1999, at 5:07:10
>
> I am familiar with the Pindolol+Buspar thing. For a cool presentation of that plus some other related stuff, go to http://www.med.nyu.edu/Psych/aug/index.htm
>
> It is a presentation by NYU. You can choose either text or graphic. Both are cool. It discusses that Pindolol+Buspar study and shows a graphic illustration of how it theoretically works and also the results of the study. I tried the combo for a week but found the confusion, weakness, dizziness too much at the time. I didn't have the heart to continue, but I should have. I was trying to duplicate the study, but in hindsight I should have started at lower doses.
>
> Anyway, check it out.--------
Thanks for the tip, John L. So far there's a little dizziness and fatigue, but it passes quickly and doesn't really bother me.Three quick questions:
When you started the Buspar/Pindolol combo, what were your dosage amounts and schedule? Did you start taking both at the same time, or were you already using oe of them? What else (if anything) were you taking with the Buspar and Pindolol?Thanks again.
Rick
Posted by JohnL on September 20, 1999, at 16:56:40
In reply to Re: alternatives to Nardil: Rick, posted by Rick on September 20, 1999, at 10:12:36
> Three quick questions:
> When you started the Buspar/Pindolol combo, what were your dosage amounts and schedule? Did you start taking both at the same time, or were you already using oe of them? What else (if anything) were you taking with the Buspar and Pindolol?
>
> Thanks again.
> RickIt was 2.5mg Pindolol 3 times a day with 5mg Buspar 3 times a day. Started both at the same time. If I ever went back for another try, I would probably use the same doses to start except maybe just once or twice a day instead of 3 times. Then work up as tolerated. I was taking nothing else at the time. It is a pretty convincing combo in literature, and it would be at the top of my list for a second try if what I'm doing now doesn't pan out. I've learned since then to go slow and low. It may have been a miraculous combo, but I was too aggressive too fast.
Posted by anita on September 20, 1999, at 19:00:07
In reply to ...AND WHERE THE HECK IS BROFAROMINE??, posted by Rick on September 20, 1999, at 3:31:03
Damn good question! I read a lot about brofaromine a while ago and was dismayed that I
couldn't find anywhere to get it. I never found out why it wasn't marketed more widely, considering
it apparently worked better than moclobemide.anita
>
> Contrary to initial reports, the reversible,
> A-selective, and thus "gentle" (no food
> restrictions or nasty side effects) MAOI
> Moclobemide has recently been shown to be fairly
> ineffective for Social Phobia. Yet tests as
> recent as 1997 by Ciba-Geigy show Brofaromine,
> another reversible, A-selective gentle MAOI to be
> VERY effective for SP (e.g., see Medline 1997
> study).
>
> So why isn't Brofaromide being manufactured
> anymore?? At least Moclobemide (Manerix) can be
> bought in Canada or mail-ordered to the U.S., but
> why wouldn't Ciba withold Brofaromide just as
> Social Phobia/Anxiety is finally being recognized
> as a HUGELY prevalent mental disorder, and
> garnering scads of press...not to mention the
> drug's base use as an AD. Is someone asleep at
> the wheel and denying the Social Phobics and MAOI
> that actually works AND won't make them give up
> cheese or sex? What gives? Geez, someone can
> make MONEY from this, no??
Posted by Rick on September 20, 1999, at 20:19:30
In reply to Re: alternatives to Nardil: Rick, posted by JohnL on September 20, 1999, at 16:56:40
>
> It is a pretty convincing combo in literature,
and it would be at the top of my list for a second try if what I'm doing now doesn't pan out. I've
learned since then to go slow and low. It may have been a miraculous combo, but I was too aggressive
too fast.
-----Well, I'd like to be optimisitic since I'm trying
it (not without my mainstay Klonopin,
though!!)...but if the startling nyu findings four years ago were valid, don't you think this combo
would have been widely reported (and presumably
used) elsewhere by now? Heck, with 50% of pdocs
calling Buspar an "expensive placebo", you'd think Bristol-Meyers-Squibb would be all over this one
by now!!Well, I've scoured every byte of the net, and have found NO reference to this combo's quick and
potent AD effects except for the nyu site (BTW,
your url was a bit off), their Medline abstract,
and our correspondence here. In fact I only found one other reference to simutaneous use of Buspar
and Pindolol in ANY context, and that was simply
to give a little extra "oomph" to restoring
pooped-out SSRI's (instead of using just one or
the other as a potentiator). And there was
certainly nothing glowing in THAT report.So wish I could say otherwise, but I'm not
brimming with optimism. Sigh...Rick
Posted by JohnL on September 22, 1999, at 4:20:38
In reply to Re: alternatives to Nardil: John L, posted by Rick on September 20, 1999, at 20:19:30
Rick, I think you're right in questioning an approach that isn't more popular than it is. I think there are two benefits with the Buspar+Pindolol approach however...first, response time is faster (if it works) so we should have a good idea of its effectiveness early on. And second, the side effect profiles of both drugs are considerably more favorable than most other drugs. So with less time invested in the trial, and easier side effects, it seems to have some merits worth considering. I understand it's nearly impossible to be optimistic. I'm always hesitant about my own treatments as well. I will however remain optimistic for you. Here's wishing you good results. :)
Posted by Elizabeth on September 24, 1999, at 22:39:11
In reply to Re: ...AND WHERE THE HECK IS BROFAROMINE??, posted by anita on September 20, 1999, at 19:00:07
I believe brofaromine is an SRI in addition to being a RIMA...the combination probably accounts for why it actually works .
It's available (as Consonar) in some countries (not sure which ones but I believe France is among them). A third one, toloxatone, can also be found in some places (Switzerland and France, e.g.).
Posted by Jen on September 28, 1999, at 11:24:41
In reply to Re: alternatives to Nardil: Rick, posted by JohnL on September 20, 1999, at 16:56:40
I continue to see clinicial research implicating the GABAergic system in the pathology of social phobia. Perhaps you should discuss with your psychopharmacologist a limited trial with a GABA-A agonist, such as Tiagabine, Progabide, or one of the other new AED's
>
> > Three quick questions:
> > When you started the Buspar/Pindolol combo, what were your dosage amounts and schedule? Did you start taking both at the same time, or were you already using oe of them? What else (if anything) were you taking with the Buspar and Pindolol?
> >
> > Thanks again.
> > Rick
>
> It was 2.5mg Pindolol 3 times a day with 5mg Buspar 3 times a day. Started both at the same time. If I ever went back for another try, I would probably use the same doses to start except maybe just once or twice a day instead of 3 times. Then work up as tolerated. I was taking nothing else at the time. It is a pretty convincing combo in literature, and it would be at the top of my list for a second try if what I'm doing now doesn't pan out. I've learned since then to go slow and low. It may have been a miraculous combo, but I was too aggressive too fast.
Posted by Carmen on September 28, 1999, at 13:17:35
In reply to Re: alternatives to Nardil: Tiagabine, Progabide?, posted by Jen on September 28, 1999, at 11:24:41
> I continue to see clinicial research implicating the GABAergic system in the pathology of social phobia. Perhaps you should discuss with your psychopharmacologist a limited trial with a GABA-A agonist, such as Tiagabine, Progabide, or one of the other new AED's
> >
> > > Three quick questions:
> > > When you started the Buspar/Pindolol combo, what were your dosage amounts and schedule? Did you start taking both at the same time, or were you already using oe of them? What else (if anything) were you taking with the Buspar and Pindolol?
> > >
> > > Thanks again.
> > > Rick
> >
> > It was 2.5mg Pindolol 3 times a day with 5mg Buspar 3 times a day. Started both at the same time. If I ever went back for another try, I would probably use the same doses to start except maybe just once or twice a day instead of 3 times. Then work up as tolerated. I was taking nothing else at the time. It is a pretty convincing combo in literature, and it would be at the top of my list for a second try if what I'm doing now doesn't pan out. I've learned since then to go slow and low. It may have been a miraculous combo, but I was too aggressive too fast.
Jen, Hi! Is Neurontin one of the new AEDs? Cause I don't know what you're talking about. Alls I know is that as of Aug. 1999 it was approved for social anxiety and is having wonderful success in patients including me. Thanks for your input. Carmen
Posted by Jen on September 30, 1999, at 11:06:07
In reply to Re: alternatives to Nardil: Tiagabine, Progabide?, posted by Carmen on September 28, 1999, at 13:17:35
Hi, Carmen
Yes, Nerontin is one of the new AED's. It was originally intended to be a GABA agonist, but its actual mechanism of action is unknow. For example, it doesn't increase whole brain levels of GABA. There appear to be a number of people who benefit fromm Nerontin (Gabapentin), but its efficacy is not universal across all with generalized sub-type social phobia. I've tried it up to 3600 mg/day, with no apparent effect. However, if it works for you, I'd definitely keep on it. The etiology of social phobia is still very poorly understood. Which neurotransmitters are implicated? Is there a combination of neurotransmitters? Which nerotransmitter subtypes are key? Are all the sub-type receptors known? Etc. Etc.
By the way, congratulations and my wishes for continued good luck.
Posted by Rick on September 30, 1999, at 11:41:04
In reply to Re: Neurontin follow-up, posted by Jen on September 30, 1999, at 11:06:07
> Hi, Carmen
>
> Yes, Nerontin is one of the new AED's. It was originally intended to be a GABA agonist, but its actual mechanism of action is unknow. For example, it doesn't increase whole brain levels of GABA. There appear to be a number of people who benefit fromm Nerontin (Gabapentin), but its efficacy is not universal across all with generalized sub-type social phobia. I've tried it up to 3600 mg/day, with no apparent effect. However, if it works for you, I'd definitely keep on it. The etiology of social phobia is still very poorly understood. Which neurotransmitters are implicated? Is there a combination of neurotransmitters? Which nerotransmitter subtypes are key? Are all the sub-type receptors known? Etc. Etc.
>
> By the way, congratulations and my wishes for continued good luck.Carmen - Great news about your success with Neurontin for SP. The August study showed significant, but not overly impressive, impact of Neurontin on SP. But what's important, of course, is what works for YOU, and apparently this has "clicked" for your body chemistry and symptoms.
Can I ask a few questions?:
-- How much Neurontin are you taking, and when?
-- What other meds (if any) do you take?
-- Are/were you hypertensive or fast heartbeat?
-- How long did it take for results to kick in?
-- Briefly, what are your primary SP symptoms (as
Jen said, there is wide variation by person).
Does the Neurontin work better for some of
your symptoms than others?Thanks in advance for this useful info!
Rick
Posted by MARKED on January 17, 2004, at 15:49:03
In reply to ...AND WHERE THE HECK IS BROFAROMINE??, posted by Rick on September 20, 1999, at 3:31:03
This is so very interesting, thank you.
I am contemplating : brofaromide/neurontin mix,
I originally thought Moclobemide with Trileptal but am unaware of this mix (or subsequent info of patients trying it, or weather they are compatible..My doctor seems to think all antidepressents are not compatable with Tegretol (for example), but she seems misinformed)
Also I have considered Neurontin because of good feedback generally, and info.
Your post has awakened new insights.Moclobemide is freely obtainable as a prescription in Australia (where I am), i'll have to look into brofaromide's availabilty here.
> Contrary to initial reports, the reversible,
> A-selective, and thus "gentle" (no food
> restrictions or nasty side effects) MAOI
> Moclobemide has recently been shown to be fairly
> ineffective for Social Phobia. Yet tests as
> recent as 1997 by Ciba-Geigy show Brofaromine,
> another reversible, A-selective gentle MAOI to be
> VERY effective for SP (e.g., see Medline 1997
> study).
>
> So why isn't Brofaromide being manufactured
> anymore?? At least Moclobemide (Manerix) can be
> bought in Canada or mail-ordered to the U.S., but
> why wouldn't Ciba withold Brofaromide just as
> Social Phobia/Anxiety is finally being recognized
> as a HUGELY prevalent mental disorder, and
> garnering scads of press...not to mention the
> drug's base use as an AD. Is someone asleep at
> the wheel and denying the Social Phobics and MAOI
> that actually works AND won't make them give up
> cheese or sex? What gives? Geez, someone can
> make MONEY from this, no??
Posted by MARKED on January 17, 2004, at 15:55:12
In reply to ...AND WHERE THE HECK IS BROFAROMINE??, posted by Rick on September 20, 1999, at 3:31:03
This abstarct was very welcoming to read as well, in relation to Brofaromide/Moclobemide clinical studies:
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2001000400032&lng=en&nrm=iso&tlng=enHope all get the treatment they are searching for.
> > HI,
> >
> > I HAVE TERRIBLE "SOCIAL PHOBIA." MY PSYCHDOC HAS
> PRESCRIBED NARDIL AND KLONPIN. BOTH ARE VERY
> EFFECTIVE, BUT THE KNOLONPIN MAKES ME DROWSY. THE
> PURPOSE FOR USING KLONOPIN AS AN ADJUNCT, I'M
> TOLD, IS TO SUPPLEMENT THE NARDIL. THAT IS,
> NARDIL, FIRST, AND THEN LOW STEADY STATE DOSE OF
> KLONOPIN. MY PROBLEM IS NARDIL HAS CAUSED ME TO
> GAIN OVER 20 POUNDS, AND HAS ALSO CAUSED 100%
> ANORGASMIA. HAS ANYONE TRIED ANYTHING ELSE THAT
> WORKED BETTER THAN NARDIL, WITHOUT THE SIDE
> EFFECTS. MY SEARCH OF MEDLINE INDICATES THAT THE
> SSRI'S AND THEIR COUSINS GENERALLY ARE NO BETTER
> THAN RELIEVING 40-45% OF THE SYMPTOMS, COMPARED
> WITH PLACEBO EFFECT OF 20-25%. I DON'T WANT THE
> SAME PROBLEMS ASSOCIATED WITH SSRI'S (SEXUAL
> DYSFUNCTION), WITH SUCH A LOWER LEVEL OF EFFICACY
> COMPARED TO NARDIL. BASICALLY, THEY SEEM TO OFFER
> ALL THE NEGATIVES WITHOUT THE BENEFIT, FOR SOCIAL
> PHOBIA, THAT IS. I HAVEN'T HEARD ANYTHING ABOUT
> REBOXETINE (IN TREATING SP), WHICH IS SOON TO BE
> RELEASED IN THE US (4TH QTR 1999). ALSO,
> UNDERSTAND GABAPENTIN AND ONDANSETRON DIDN'T MAKE
> IT THROUGH STAGE III TRIALS DUE TO LACK OF
> EFFICACY.
> >
> > THERE HAS TO BE SOMETHING! BY THE WAY,
> PARNATE'S EFFICACY IN TREATING SP IS EQUIVOCAL.
> >
> > ANY IDEAS?????????????????
>
> --------
>
> Contrary to initial reports, the reversible,
> A-selective, and thus "gentle" (no food
> restrictions or nasty side effects) MAOI
> Moclobemide has recently been shown to be fairly
> ineffective for Social Phobia. Yet tests as
> recent as 1997 by Ciba-Geigy show Brofaromine,
> another reversible, A-selective gentle MAOI to be
> VERY effective for SP (e.g., see Medline 1997
> study).
>
> So why isn't Brofaromide being manufactured
> anymore?? At least Moclobemide (Manerix) can be
> bought in Canada or mail-ordered to the U.S., but
> why wouldn't Ciba withold Brofaromide just as
> Social Phobia/Anxiety is finally being recognized
> as a HUGELY prevalent mental disorder, and
> garnering scads of press...not to mention the
> drug's base use as an AD. Is someone asleep at
> the wheel and denying the Social Phobics and MAOI
> that actually works AND won't make them give up
> cheese or sex? What gives? Geez, someone can
> make MONEY from this, no??
Posted by MARKED on January 20, 2004, at 6:06:17
In reply to Re: ...AND WHERE THE HECK IS BROFAROMINE??, posted by Elizabeth on September 24, 1999, at 22:39:11
I agree....Looking into it's availabity in Australia. Moclobemide is available here, so unless there is a clash of interests with pharmecuetical companies i can't see why not.
> I believe brofaromine is an SRI in addition to being a RIMA...the combination probably accounts for why it actually works .
>
> It's available (as Consonar) in some countries (not sure which ones but I believe France is among them). A third one, toloxatone, can also be found in some places (Switzerland and France, e.g.).
Posted by SLS on January 20, 2004, at 6:20:21
In reply to Re: ...AND WHERE THE HECK IS BROFAROMINE??, posted by MARKED on January 20, 2004, at 6:06:17
Brofaromine was available briefly in Europe. I don't remember in which countries. It was discontinued quite a few years ago. I'm not sure why. I doubt you will see it again.
- Scott
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