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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by TheOutsider on November 17, 2004, at 17:18:08
Hi every one
I live in the UK and suffer from social anxiety which is making my life a bit of a misery at the moment.
I have not responded to SSRIs or Clomipramine and would be willing to try an MAOI since I think that they could really help me.I've made an appointment to see a private doctor next Thursday, because the help I have recieved on the NHS (National Health Service)has been inadequite.
I have never met this doctor before. I spoke to him briefly on the phone, he seemed like a nice guy, but when I mentioned MAOIs he laughed and said he never used them as there are newer and more effective treatments (!)I assume that he is just ignorent about MAOIs since he is quite young.
Is there any evidence that demonstrates that MAOIs are reasonably safe when used apropriatly, and also that they are more effictive than SSRIs and Tryciclics for Social anxiety?
Posted by King Vultan on November 18, 2004, at 0:47:42
In reply to Evidence that MAOIs are good for Social Anxiety?, posted by TheOutsider on November 17, 2004, at 17:18:08
> Hi every one
>
> I live in the UK and suffer from social anxiety which is making my life a bit of a misery at the moment.
> I have not responded to SSRIs or Clomipramine and would be willing to try an MAOI since I think that they could really help me.
>
> I've made an appointment to see a private doctor next Thursday, because the help I have recieved on the NHS (National Health Service)has been inadequite.
> I have never met this doctor before. I spoke to him briefly on the phone, he seemed like a nice guy, but when I mentioned MAOIs he laughed and said he never used them as there are newer and more effective treatments (!)
>
> I assume that he is just ignorent about MAOIs since he is quite young.
> Is there any evidence that demonstrates that MAOIs are reasonably safe when used apropriatly, and also that they are more effictive than SSRIs and Tryciclics for Social anxiety?
>
Well, there is certainly a lot of anecdotal evidence that MAOIs are safe in the long term, judging from what I've read here and elsewhere. Clearly, a person who takes an MAOI needs to be at least somewhat conscientious and aware in the selection of foods, and also avoid other drugs that can cause a reaction (decongestants are probably the most important common type). Many of the prohibited food lists have a lot of things that really shouldn't be on them, such as chocolate and wine, and are missing a few items that really should be on them, such as tap (draft) beer and sauerkraut. The absolute number of items is not that great, and the big one is the aged cheeses, with cheddar being the best and most notorious example.I have a book "Clinical Advances in Monoamine Oxidase Inhibitor Therapies" that has a section on MAOIs and social phobia. It seems clear to me from reading the book, as well as anecdotal evidence I've seen here and elsewhere, that the MAOIs do have a superior ability to treat social anxiety compared to any other type of antidepressant. The book also makes the case that they are excellent for panic disorder, which some social phobia sufferers are also afflicted with (I'm currently reading another book specifically on social anxiety disorder), and of course, there is ample evidence that the MAOIs are excellent antidepressants, too. In fact, all things considered, the MAOIs are probably the most versatile and efficacious drugs in the antidepressant class. I believe they are drastically underused.
Todd
Posted by TheOutsider on November 18, 2004, at 4:22:59
In reply to Re: Evidence that MAOIs are good for Social Anxiety?, posted by King Vultan on November 18, 2004, at 0:47:42
MAOIs are probably the most versatile and efficacious drugs in the antidepressant class. I believe they are drastically underused.
>
> ToddHigh Todd, I agree that MAOIs are excellent anti depressents, the problem is finding evidence that would convince a sceptical doctor.
I don't think that he will be very impressed if I tell him that I think MAOIs are very effective and that the evidence for this comes from an internet chat board!
I need studies and comments from doctors which support the use of MAOIs.
Posted by ed_uk on November 18, 2004, at 7:38:37
In reply to Re: Evidence that MAOIs are good for Social Anxiety?, posted by TheOutsider on November 18, 2004, at 4:22:59
A study for TheOutsider. Nardil is the trade name for the drug phenelzine, a classical MAOI.....
World J Biol Psychiatry. 2000 Jan;1(1):27-33. Related Articles, Links
A review of 19 double-blind placebo-controlled studies in social anxiety disorder (social phobia).Versiani M.
Department of Psychiatry, Federal University of Rio de Janeiro, R. Visconde de Piraja 407 s. 805, Rio de Janeiro, 22410-003, Brazil. versiani@openlink.com.br
Nineteen double-blind placebo-controlled studies on the treatment of Social Anxiety Disorder (Social Phobia) are reviewed. Initial trials yielded a high degree of efficacy for phenelzine, a large difference between drug and placebo and a low rate of placebo response. Controlled studies with RIMAs (moclobemide and brofaromine) yielded more moderate levels of efficacy and more pronounced placebo effects. Results of the Liebowitz Social Anxiety Scale (LSAS) permit a comparison of the outcomes of the different controlled trials. Overall, the reduction in the mean total score with various drugs is inferior to 50%, probably because the chronic nature of the disorder is not amenable to drastic changes in short-term trials. Results with the LSAS and other scales justify a ranking of the efficacy of the drugs: Classical MAOIs > SRIs > RIMAs. Two controlled studies with benzodiazepines (clonazepam and bromazepam) would position them together with the SRIs relative to efficacy but with problems associated with unwanted effects and dependence. Controlled studies with SRIs (paroxetine and fluvoxamine) demonstrated very significant differences from placebo. Paroxetine is the SRI most extensively studied in Social Anxiety Disorder with positive therapeutic results.
Hope this helps....
Ed.
Posted by King Vultan on November 18, 2004, at 8:19:36
In reply to Re: Evidence that MAOIs are good for Social Anxiety?, posted by TheOutsider on November 18, 2004, at 4:22:59
> MAOIs are probably the most versatile and efficacious drugs in the antidepressant class. I believe they are drastically underused.
> >
> > Todd
>
> High Todd, I agree that MAOIs are excellent anti depressents, the problem is finding evidence that would convince a sceptical doctor.
>
> I don't think that he will be very impressed if I tell him that I think MAOIs are very effective and that the evidence for this comes from an internet chat board!
> I need studies and comments from doctors which support the use of MAOIs.
Well, here is one from some doctors who routinely use MAOIs, with their thoughts on safety and dosing:http://www.currentpsychiatry.com/2002_06/06_02_maoi.asp
Todd
Posted by crazychickuk on November 18, 2004, at 18:18:50
In reply to Re: Evidence that MAOIs are good for Social Anxiety? » TheOutsider, posted by King Vultan on November 18, 2004, at 8:19:36
Outsider i am i nthe uk too, how did you manage to get to see a private doc? do u have to get refered by nhs gp?
thanks
Posted by TheOutsider on November 20, 2004, at 13:25:13
In reply to Re: Evidence that MAOIs are good for Social Anxiety?, posted by crazychickuk on November 18, 2004, at 18:18:50
A
Posted by Dave001 on November 21, 2004, at 17:46:14
In reply to Evidence that MAOIs are good for Social Anxiety?, posted by TheOutsider on November 17, 2004, at 17:18:08
> I've made an appointment to see a private doctor next Thursday, because the help I have recieved on the NHS (National Health Service)has been inadequite.
> I have never met this doctor before. I spoke to him briefly on the phone, he seemed like a nice guy, but when I mentioned MAOIs he laughed and said he never used them as there are newer and more effective treatments (!)Do yourself a favor and schedule an appointment with a doctor who does prescribe MAOIs. Make it clear on the phone that you want to try an MAOI. You'll just be wasting your time and money on this doc you've made an appointment with.
Posted by Dan Perkins on November 22, 2004, at 12:51:24
In reply to Re: Evidence that MAOIs are good for Social Anxiet, posted by Dave001 on November 21, 2004, at 17:46:14
> > I've made an appointment to see a private doctor next Thursday, because the help I have recieved on the NHS (National Health Service)has been inadequite.
> > I have never met this doctor before. I spoke to him briefly on the phone, he seemed like a nice guy, but when I mentioned MAOIs he laughed and said he never used them as there are newer and more effective treatments (!)
>
> Do yourself a favor and schedule an appointment with a doctor who does prescribe MAOIs. Make it clear on the phone that you want to try an MAOI. You'll just be wasting your time and money on this doc you've made an appointment with.
>
Let me just emphasize what Dave001 said: you owe it to yourself to cancel your appointment and to find a pdoc who has experience with and is willing to prescribe an MAOI. This pdoc you are scheduled to see has apparently bought into the hype that the pharmaceutical companies use to steer patients away from off-patent medications (MAOIs, for example) towards patented drugs (SSRIs) to fatten their own bottom lines.
Posted by Questionmark on November 23, 2004, at 14:38:48
In reply to Re: Evidence that MAOIs are good for Social Anxiet, posted by Dan Perkins on November 22, 2004, at 12:51:24
i agree with this, ideally, but it's not that easy-- especially in the UK probably. i'm in the freaking States and about a month ago i called every psychiatrist i could find in two phonebooks for the surrounding area. i did this because i currently have to travel 2 hours to see my psychiatrist (who prescribes me my Nardil), and i wanted to see if i could find someone closer.
Each time i called and spoke to the doctor or, usually, the secretary, i said something like "i'm interested in seeing Dr. So-and-So, but i would like to know if he/she is willing to prescribe an MAOI before i make an appointment", they would reply "Well I don't know, that would be his/her decision and s/he would have to talk to you first ." Then i would say "No i know, i'm just wondering if s/he would be WILling to prescribe it. i know i would have to talk to him/her first. It's just that some psychiatrists don't prescribe these medications anymore and i don't want to spend all the money (and the time) on an appointment if s/he is not even willing to presribe them." And then they would just say the same stupid thing to me like they weren't even listening. i swear there's something about secretaries who work in psychiatric offices-- so many are ignorant [can't-use-the-word]s (*AND NO NOT ALL, i said "MANY"). Of course, the same is true with many psychiatrists. There's something wrong with the whole psychiatric industry. i don't get it.
Anyway, sorry for that long shpiel. My point is that it might not be that simple for TheOutsider to find a psychiatrist who is willing to prescribe MAOIs-- particularly to determine whether one does or not.> > > I've made an appointment to see a private doctor next Thursday, because the help I have recieved on the NHS (National Health Service)has been inadequite.
> > > I have never met this doctor before. I spoke to him briefly on the phone, he seemed like a nice guy, but when I mentioned MAOIs he laughed and said he never used them as there are newer and more effective treatments (!)
> >
> > Do yourself a favor and schedule an appointment with a doctor who does prescribe MAOIs. Make it clear on the phone that you want to try an MAOI. You'll just be wasting your time and money on this doc you've made an appointment with.
> >
>
>
> Let me just emphasize what Dave001 said: you owe it to yourself to cancel your appointment and to find a pdoc who has experience with and is willing to prescribe an MAOI. This pdoc you are scheduled to see has apparently bought into the hype that the pharmaceutical companies use to steer patients away from off-patent medications (MAOIs, for example) towards patented drugs (SSRIs) to fatten their own bottom lines.
Posted by King Vultan on November 24, 2004, at 13:04:23
In reply to Finding a pdoc who prescribes MAOIs, posted by Questionmark on November 23, 2004, at 14:38:48
> i agree with this, ideally, but it's not that easy-- especially in the UK probably. i'm in the freaking States and about a month ago i called every psychiatrist i could find in two phonebooks for the surrounding area. i did this because i currently have to travel 2 hours to see my psychiatrist (who prescribes me my Nardil), and i wanted to see if i could find someone closer.
> Each time i called and spoke to the doctor or, usually, the secretary, i said something like "i'm interested in seeing Dr. So-and-So, but i would like to know if he/she is willing to prescribe an MAOI before i make an appointment", they would reply "Well I don't know, that would be his/her decision and s/he would have to talk to you first ." Then i would say "No i know, i'm just wondering if s/he would be WILling to prescribe it. i know i would have to talk to him/her first. It's just that some psychiatrists don't prescribe these medications anymore and i don't want to spend all the money (and the time) on an appointment if s/he is not even willing to presribe them." And then they would just say the same stupid thing to me like they weren't even listening. i swear there's something about secretaries who work in psychiatric offices-- so many are ignorant [can't-use-the-word]s (*AND NO NOT ALL, i said "MANY"). Of course, the same is true with many psychiatrists. There's something wrong with the whole psychiatric industry. i don't get it.
> Anyway, sorry for that long shpiel. My point is that it might not be that simple for TheOutsider to find a psychiatrist who is willing to prescribe MAOIs-- particularly to determine whether one does or not.
>I only have experience dealing with a couple of branches of a clinic where both my GP and pdoc work, but my experience when calling in on technical issues is that I am inevitably referred to a nurse, who then communicates with the doctor on my specific question and gets back to me. I don't know if it's necessarily reasonable to expect the receptionists and such who answer the phones to have that much familiarity with all the different drugs that are available, particularly when it's something as obscure as an MAOI. In fact, I now typically ask in the beginning of the conversation to speak to my doctor's nurse regarding a dosage question, refill, problem, etc.
I called in a couple weeks ago and asked to speak to my pdoc's nurse about increasing my dosage of Parnate, and the lady who answered the phone asked me to repeat the name of the drug because she had never heard of it. Now here, I was actually a bit surprised, as I would think this drug is at least notorious enough that she would have heard of it, even though it isn't prescribed much. OTOH, my pdoc said it had been about 10 years since he had used it, and I don't know if the other psychiatrists in the office even use it at all. Anyway, the nurse seemed to be on the ball when I spoke with her later, and she then conferred with my pdoc and called me back to say that it was okay to go up in dosage. This system seems to work pretty well unless a person's situation is unusually complicated. In those cases, it may be better to just go in and see the doctor.
Todd
Posted by Questionmark on November 25, 2004, at 18:54:44
In reply to Re: Finding a pdoc who prescribes MAOIs » Questionmark, posted by King Vultan on November 24, 2004, at 13:04:23
> > i agree with this, ideally, but it's not that easy-- especially in the UK probably. i'm in the freaking States and about a month ago i called every psychiatrist i could find in two phonebooks for the surrounding area. i did this because i currently have to travel 2 hours to see my psychiatrist (who prescribes me my Nardil), and i wanted to see if i could find someone closer.
> > Each time i called and spoke to the doctor or, usually, the secretary, i said something like "i'm interested in seeing Dr. So-and-So, but i would like to know if he/she is willing to prescribe an MAOI before i make an appointment", they would reply "Well I don't know, that would be his/her decision and s/he would have to talk to you first ." Then i would say "No i know, i'm just wondering if s/he would be WILling to prescribe it. i know i would have to talk to him/her first. It's just that some psychiatrists don't prescribe these medications anymore and i don't want to spend all the money (and the time) on an appointment if s/he is not even willing to presribe them." And then they would just say the same stupid thing to me like they weren't even listening. i swear there's something about secretaries who work in psychiatric offices-- so many are ignorant [can't-use-the-word]s (*AND NO NOT ALL, i said "MANY"). Of course, the same is true with many psychiatrists. There's something wrong with the whole psychiatric industry. i don't get it.
> > Anyway, sorry for that long shpiel. My point is that it might not be that simple for TheOutsider to find a psychiatrist who is willing to prescribe MAOIs-- particularly to determine whether one does or not.
> >
>
> I only have experience dealing with a couple of branches of a clinic where both my GP and pdoc work, but my experience when calling in on technical issues is that I am inevitably referred to a nurse, who then communicates with the doctor on my specific question and gets back to me. I don't know if it's necessarily reasonable to expect the receptionists and such who answer the phones to have that much familiarity with all the different drugs that are available, particularly when it's something as obscure as an MAOI. In fact, I now typically ask in the beginning of the conversation to speak to my doctor's nurse regarding a dosage question, refill, problem, etc.
>
> I called in a couple weeks ago and asked to speak to my pdoc's nurse about increasing my dosage of Parnate, and the lady who answered the phone asked me to repeat the name of the drug because she had never heard of it. Now here, I was actually a bit surprised, as I would think this drug is at least notorious enough that she would have heard of it, even though it isn't prescribed much. OTOH, my pdoc said it had been about 10 years since he had used it, and I don't know if the other psychiatrists in the office even use it at all. Anyway, the nurse seemed to be on the ball when I spoke with her later, and she then conferred with my pdoc and called me back to say that it was okay to go up in dosage. This system seems to work pretty well unless a person's situation is unusually complicated. In those cases, it may be better to just go in and see the doctor.
>
> Todd
Good advice Todd. Unfortunately not every pdoc has a nurse under him/her. But for those who do, that's a good idea.
Also, bytheway, you said: "I don't know if it's necessarily reasonable to expect the receptionists and such who answer the phones to have that much familiarity with all the different drugs that are available, particularly when it's something as obscure as an MAOI."
i totally agree. i would not just ask the receptionist if Dr. So-and-So is willing to prescribe MAO inhibitors and leave it at that. i would either ask to speak to Dr. So-and-So, or i would say something like "Do you know if Dr So-and-So is willing to prescribe an MAO inhibitor at all?" and if they did not know, i would then ask if it would be possible to speak to that Dr. at some point.
Posted by CareBear04 on November 26, 2004, at 0:17:40
In reply to Re: Finding a pdoc who prescribes MAOIs » King Vultan, posted by Questionmark on November 25, 2004, at 18:54:44
hey questionmark,
i'm wondering the same thing about doctors and MAOIs. i've been through most all of the new generation antidepressants. the expert psychopharmacologist i consulted said tricyclics are evil for bipolar patients, ruling those out. i asked about MAOIs, and he said they're an option, but he was concerned about the side effects and interactions. i feel willing to take on the risks. i know that MAOIs can be powerful meds for depression, I'm conscientious and don't eat most of the restricted foods, anyway, and i'm not suicidal and not about to use the drugs to cause death. most all of the psychiatrists i've seen are too young to have been around before SSRIs and such, and they are super-wary of the old. it's like my experience recently with lithium. i've been getting very toxic at low doses and no doctor has been able to explain it. when i started to crash, i saw about four psychiatrists who agreed that lithium was needed in theory, but only one was willing to write the script. i think it's the same with MAOIs-- good in theory but risky in practice-- and i don't know how to find a doctor who is willing to try them with me. if you find out, please let me know. cb
Posted by Questionmark on November 26, 2004, at 11:46:18
In reply to Re: Finding a pdoc who prescribes MAOIs, posted by CareBear04 on November 26, 2004, at 0:17:40
> hey questionmark,
> i'm wondering the same thing about doctors and MAOIs. i've been through most all of the new generation antidepressants. the expert psychopharmacologist i consulted said tricyclics are evil for bipolar patients, ruling those out. i asked about MAOIs, and he said they're an option, but he was concerned about the side effects and interactions. i feel willing to take on the risks. i know that MAOIs can be powerful meds for depression, I'm conscientious and don't eat most of the restricted foods, anyway, and i'm not suicidal and not about to use the drugs to cause death. most all of the psychiatrists i've seen are too young to have been around before SSRIs and such, and they are super-wary of the old. it's like my experience recently with lithium. i've been getting very toxic at low doses and no doctor has been able to explain it. when i started to crash, i saw about four psychiatrists who agreed that lithium was needed in theory, but only one was willing to write the script. i think it's the same with MAOIs-- good in theory but risky in practice-- and i don't know how to find a doctor who is willing to try them with me. if you find out, please let me know. cb
Yeah, i understand what you're saying. It's so frusterating. It's so frusterating for mE to even hear about this stuff with other people. It drives me nuts. But..
Yeah, here are potentially worthwhile suggestions: try to find a pdoc who-- if you can find out-- is willing to prescribe MAOIs, or if you are not able to determine this about any, then try to see the oldest pdoc you can find (most everything else being equal, at least). The older doctors, as you basically pointed out, are much more likely to prescribe an MAOI. Next, after you have a psychiatrist, tell him/her that you want to try an MAOI and that you have tried many of the newer medications, etc. And if s/he is reluctant, show him/her as many positive research articles on an MAOI as you can, as well as even good nonresearch articles such as the one from a webpage that was given by someone previously in this thread (www.currentpsychiatry.com/2002_06/06_02_maoi.asp). But be sure to try and act as innocent and nonconfrontational and etc. etc. etc. as possible (because many psychiatrists react very poorly to a patient who tries to direct his own treatment or questions the judgement of the doctor a lot and such-- quite unfortunate but it's true in my opinion). After doing that, and after being as patient and courteous (etc.) as possible, if the doctor still wants to prescribe something other than an MAOI, then (unless you want to try it) tell him/her that you do not want [prescribed] drug and will no longer be seeing him/her anymore, since it is your sincere and strong conviction that you should be able to try, and should try, and MAO inhibitor. Then, unless the doctor has an extremely unlikely, miraculous turn-around and conceeds to prescribe an MAOI... try another doc. It may take awhile, but stubborn and/or ignorant psychiatrists such as these should not be supported, if possible, and also, once you get on an MAOI (especially Nardil, IMO), if it is effective (which it should be), it will have been well worth the effort and the wait.
Oh, one more thing. Be sure to somehow convince your psychiatrist that many of the foods/drinks on the dietary restrictions list should not be on there-- because it's the truth. Use research articles/abstracts, scientific non-research articles, and maybe even a collection of anecdotes from people on an MAOI from places such as this (Dr-Bob/PsychoBabble)-- or whatever else.
Best of luck to you.
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