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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Rocket Jackson on August 3, 2002, at 0:10:32
Hey Everybody,
I'm in need of some urgent advice about which med to request from my physician in my upcoming appointment to add to my pre-existing Klonopin regimen for social anxiety disorder. I tried Provigil along with it, but wasn't too impressed with the results. And because of side effects (I'm young and married, and the weight gain and sexual dysfunction are not desirable at this time), I refuse to try an MAOI or SSRI. Therefore, I'm primarily considering the following:
Wellbutrin - haven't seen much evidence of benefit from this for SAD, but its mechanism of action seems like it may prove to be a good adjunct along with Klonopin (Klonopin should curb the anxiety from the Wellbutrin hopefully)
Neurontin - the jury seems to be out on this one. I gather that some have benefited and some haven't. While the water retention may be bothersome, I still may be willing to give it a try.
Gabitril - again, I haven't seen much for anecdotal evidence of benefit for this in SAD treatment, but it may be a helpful med. During a recent CME conference in my Psychiatry rotation (I'm a fourth year med student), a leading researcher on the effects of Gabitril seemed to indicate that this drug may be far superior to similar GABA enhancing/potentiating meds for conditions such as anxiety. However, he stressed that the drug must be used in far lower doses than those used for seizure disorder (he suggested around 4-8mg, preferably before a meal). I spoke to him after the conference (difficult with the SAD :)), and though he still advocated an SSRI as first-line treatment for SAD, he admitted that Gabitril may indeed be of benefit.
Serzone - this seems to help some out there, but I'm a little worried about possible weight gain and sexual side effects.
Anyway, I'd really appreciate any advice on some of these meds. Though I've noticed some solid results from the Klonopin alone, I still feel I need some "baseline" treatment to supplement. Thanks for any advice anyone can offer!
Rocket
Posted by Shawn. T. on August 3, 2002, at 1:53:44
In reply to Urgent advice needed for a social anxiety med!!!, posted by Rocket Jackson on August 3, 2002, at 0:10:32
I would recommend Wellbutrin. Because you are on Klonopin, you should not experience the intitial agitation that is a potential side effect of Wellbutrin during the first few weeks of treatment. I am of the opinion that high noradrenaline levels often play a role in social anxiety disorder (note that some sources argue for a role for dopamine as well). Although Wellbutrin is a noradrenaline reuptake inhibitor, it effectively decreases noradrenaline levels in the brain after a certain period of time. Its mild effects on dopamine reuptake inhibition may aid in social anxiety disorder; I would argue that this function may give you more energy and motivation in social situations. I do not have a problem with social anxiety, but I have found that Wellbutrin makes me less worried about how others might perceive me in social situations. You should have no problem tolerating Wellbutrin as long as you don't start off with a high dose (that applies to all psychiatry drugs really).
"HAM-A scores decreased by 59% for both treatment groups."
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=21628184
"Time to clinically significant anxiolysis did not differentiate between treatment groups or between responders to each agent [Wellbutrin and Zoloft]. These results contradict the commonly held, but unsubstantiated, belief that in clinically depressed anxious patients, serotonergic antidepressants are especially anxiolytic and that such patients preferentially benefit from the antidepressant or anxiolytic effects of selective serotonin reuptake inhibitors. Thus, the clinical decision to select between these two agents when treating depressed outpatients cannot rest on either levels of pretreatment anxiety or on anticipation of more rapid or more complete anxiolysis."
http://www4.infotrieve.com/search/databases/detailsNew.asp?artID=29135235
Here is some information on the Hamilton Anxiety Scale:
http://www.fpnotebook.com/PSY71.htmShawn
Posted by JonW on August 3, 2002, at 6:11:51
In reply to Urgent advice needed for a social anxiety med!!!, posted by Rocket Jackson on August 3, 2002, at 0:10:32
Hi Rocket,
If you haven't tried it, don't rule out moclobemide a reversible MAOI -- no dietary restrictions. Also no sexual dysfunction which is a big plus :) The downside is it's not available in the US, of course. You can have your pdoc write a prescription and you can order it from Canada, etc. A large controlled study published just last month showed it effective for SP after 12 weeks and was still effective for the responders after 6 months.
Jon
Posted by judy1 on August 3, 2002, at 12:23:15
In reply to Urgent advice needed for a social anxiety med!!!, posted by Rocket Jackson on August 3, 2002, at 0:10:32
And since you had such a nice response to klonopin, I would add xanax prn for difficult times. It's part of my regime and works extremely well. take care, judy
Posted by Maximus on August 3, 2002, at 20:56:10
In reply to Re: Urgent advice needed for a social anxiety med!!! » Rocket Jackson, posted by JonW on August 3, 2002, at 6:11:51
> If you haven't tried it, don't rule out moclobemide a reversible MAOI -- no dietary restrictions. Also no sexual dysfunction which is a big plus :) The downside is it's not available in the US, of course.
I do completely agree. Moclobemide (Manerix here) is absolutely awesome for social anxiety. In all MAOI's categories, Moclo is probably the best out there. Super low side effect profile and safe. Moclo is also great for the libido, energy, cognition, no diet and no weight gain. Working on 5HT, NE & DA, Moclo reduces also brain's cortisol. I took it and i called it my "solid rocket booster". Give it a try. If not, you could always take a SSRI. Proven and effective. But they bring also their legions of side effects, imho.
Good luck!
Posted by cybercafe on August 4, 2002, at 7:33:17
In reply to Urgent advice needed for a social anxiety med!!!, posted by Rocket Jackson on August 3, 2002, at 0:10:32
>(I'm young and married, and the weight gain and sexual dysfunction are not desirable at this time), I refuse to try an MAOI or SSRI.
Hahahahaha... i could not lose anymore weight .... and my libido is higher than it has ever been in my life ... on Parnate
Posted by ayrity on August 4, 2002, at 21:42:49
In reply to Re: You're right Jon!, posted by Maximus on August 3, 2002, at 20:56:10
> I do completely agree. Moclobemide (Manerix here) is absolutely awesome for social anxiety. In all MAOI's categories, Moclo is probably the best out there.
>Hate to chill your enthusiasm for moclobemide, but I tried it with a good dose and length of time and it did absolutely nothing for me. No side effects, though. It is weaker and not as effective as other MAOIs, though for some people it might be enough. The lack of dietary restrictions and side effects is cool. It'll be great when more of these selective MAIOs are available with greater efficacy.
Posted by Alan on August 4, 2002, at 21:54:32
In reply to I'm a big benzo fan » Rocket Jackson, posted by judy1 on August 3, 2002, at 12:23:15
> And since you had such a nice response to klonopin, I would add xanax prn for difficult times. It's part of my regime and works extremely well. take care, judy
============================================And that's what works so well for me too...except ativan in place of the xanax. If you responded well to bzd monotherapy, why not take it to it's logical conclusion instead of going off on a tangent first?
Alan.
This is the end of the thread.
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