![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by malcolm64 on May 1, 2007, at 19:07:35
I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
I'm not talking about a crazy kind of reaction, I'm referring to just a wonderful feeling of being super-relaxed and super-confident (which is the entire reason for taking an MAOI, b/c nothing else has worked).
I did a year ago on Nardil. I first noticed the effect at about 45 mgs after about three weeks. But it slowly diminished to the point where the med wasn't having that effect anymore. So I stopped it (I went up as high as 90 mgs).
Now I'm on Parnate (I'm on 20 mgs, but go up to 30 mgs later this week). I'm hoping that it replicates some of the superconfidence I felt while the Nardil was having its peak effect. But hopefully, it won't poop out on me like the Nardil did.
I guess I'm experiencing anxiety alone just from waiting to see if the damn med is going to work.
Malcolm
Posted by Jedi on May 2, 2007, at 1:14:51
In reply to How common is hypomania on MAOI's?, posted by malcolm64 on May 1, 2007, at 19:07:35
> I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
>
> I'm not talking about a crazy kind of reaction, I'm referring to just a wonderful feeling of being super-relaxed and super-confident (which is the entire reason for taking an MAOI, b/c nothing else has worked).
>
> I did a year ago on Nardil. I first noticed the effect at about 45 mgs after about three weeks. But it slowly diminished to the point where the med wasn't having that effect anymore. So I stopped it (I went up as high as 90 mgs).
>
> Now I'm on Parnate (I'm on 20 mgs, but go up to 30 mgs later this week). I'm hoping that it replicates some of the superconfidence I felt while the Nardil was having its peak effect. But hopefully, it won't poop out on me like the Nardil did.
>
> I guess I'm experiencing anxiety alone just from waiting to see if the damn med is going to work.
>
> MalcolmHi Malcom,
Our pattern and reaction to MAOIs are very similar. My major depression started about ten years ago. Before that I went through about 25 years of dysthymia and social anxiety. After several unsuccessful trials I had a PDOC at the time who was smart enough to recognize my atypical depression with social anxiety and try Nardil. When it kicked in after about a month, the feeling was so good! I didn't care if it was hypomania, after being depressed for so long, it felt great. The feeling lasted for a couple of months but then was gone. But, the major depression was gone too.Over the past ten year perioid I quit Nardil about four times because of reduced effectiveness, side effects(weight gain/insomnia), and the desire to see if any of the newer meds would work. They all failed and the major depression returned until back on Nardil each time. I even had a failed trial on Parnate. I don't think the dosage was pushed to a high enough level. Also, we didn't try augmentation with lithium and stimulants. I really believe that modafinil would be a really good fit with Parnate. It's on my highest copay tier and I have to convince my MD, but for something that may just work, I will do what I have to. Sometimes I feel like a walking pharmacy. But, I think we all know that there are not many things worse than treatment resistant major depression. The term "Living Hell" comes to mind.
I've kind of given up on recapturing the initial reaction I had with Nardil. I just want to be able to live somewhat normally and be able to lose a large portion of the weight I gained while on Nardil and other ADs. I want to be able to talk to people without a feeling of intense anxiety. I raised my clonazepam to 2mg from 1mg when I switched to Parnate. Nardil has an effect on GABA that when combined with clonazepam makes a great social anxiety med.
Good Luck and Be Well,
Jedi
Posted by willyee on May 2, 2007, at 7:10:47
In reply to How common is hypomania on MAOI's?, posted by malcolm64 on May 1, 2007, at 19:07:35
> I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
>
> I'm not talking about a crazy kind of reaction, I'm referring to just a wonderful feeling of being super-relaxed and super-confident (which is the entire reason for taking an MAOI, b/c nothing else has worked).
>
> I did a year ago on Nardil. I first noticed the effect at about 45 mgs after about three weeks. But it slowly diminished to the point where the med wasn't having that effect anymore. So I stopped it (I went up as high as 90 mgs).
>
> Now I'm on Parnate (I'm on 20 mgs, but go up to 30 mgs later this week). I'm hoping that it replicates some of the superconfidence I felt while the Nardil was having its peak effect. But hopefully, it won't poop out on me like the Nardil did.
>
> I guess I'm experiencing anxiety alone just from waiting to see if the damn med is going to work.
>
> MalcolmAre u using klonopin as needed,it sounds like you really really should,your anxiety is getting in the way of any benifit,id seek some sort of anxiety med as needed of course just a response.
Posted by malcolm64 on May 2, 2007, at 7:18:08
In reply to Re: How common is hypomania on MAOI's?, posted by willyee on May 2, 2007, at 7:10:47
> > I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
> >
> > I'm not talking about a crazy kind of reaction, I'm referring to just a wonderful feeling of being super-relaxed and super-confident (which is the entire reason for taking an MAOI, b/c nothing else has worked).
> >
> > I did a year ago on Nardil. I first noticed the effect at about 45 mgs after about three weeks. But it slowly diminished to the point where the med wasn't having that effect anymore. So I stopped it (I went up as high as 90 mgs).
> >
> > Now I'm on Parnate (I'm on 20 mgs, but go up to 30 mgs later this week). I'm hoping that it replicates some of the superconfidence I felt while the Nardil was having its peak effect. But hopefully, it won't poop out on me like the Nardil did.
> >
> > I guess I'm experiencing anxiety alone just from waiting to see if the damn med is going to work.
> >
> > Malcolm
>
> Are u using klonopin as needed,it sounds like you really really should,your anxiety is getting in the way of any benifit,id seek some sort of anxiety med as needed of course just a response.Yes, I'm on 1.5 mgs (3 tabs of Klonopin). Is this a high enough dose?
Malcolm
Posted by Girlnterrupted on May 2, 2007, at 7:35:45
In reply to How common is hypomania on MAOI's?, posted by malcolm64 on May 1, 2007, at 19:07:35
> I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
>Wow man, I am starting Nardil in 3 weeks and it's disappointing to hear that the good feeling will wear off in a few months.
Did the medication stop working completely, or just the hypomania was gone? After the poop-out, was the social anxiety back?
I remember having hypomania while on Celexa for a whole year. It was the best year of my whole life. It might have lasted longer if my doctor hadn't decided to switch me to Lexapro. As soon as I was switched to Lexapro, the hypomania was completely gone, and even after going back to Celexa, it never came back. It's been hell ever since. Nardil was my last hope, but now not even that.
Is there anything else for atypical depression? How can there be only ONE antidepressant for it?
Posted by willyee on May 2, 2007, at 7:42:03
In reply to Re: How common is hypomania on MAOI's?, posted by malcolm64 on May 2, 2007, at 7:18:08
> > > I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
> > >
> > > I'm not talking about a crazy kind of reaction, I'm referring to just a wonderful feeling of being super-relaxed and super-confident (which is the entire reason for taking an MAOI, b/c nothing else has worked).
> > >
> > > I did a year ago on Nardil. I first noticed the effect at about 45 mgs after about three weeks. But it slowly diminished to the point where the med wasn't having that effect anymore. So I stopped it (I went up as high as 90 mgs).
> > >
> > > Now I'm on Parnate (I'm on 20 mgs, but go up to 30 mgs later this week). I'm hoping that it replicates some of the superconfidence I felt while the Nardil was having its peak effect. But hopefully, it won't poop out on me like the Nardil did.
> > >
> > > I guess I'm experiencing anxiety alone just from waiting to see if the damn med is going to work.
> > >
> > > Malcolm
> >
> > Are u using klonopin as needed,it sounds like you really really should,your anxiety is getting in the way of any benifit,id seek some sort of anxiety med as needed of course just a response.
>
> Yes, I'm on 1.5 mgs (3 tabs of Klonopin). Is this a high enough dose?
>
> MalcolmI cant answer it as u present it,def speak to a doc,but personaly it sounds a lil high for the lower end dose of parnate.
Have you moved from 20 mg?As confusing as this sounds over sedation from a benzo can also create a lot of anxiety.
I wish i could answer more,but i would need a degree,and also know ur weight and height,but i think a doc should evalute your parnate dose,with a increase in mind to happen asap,i really dont see a lot of progress on parnate until wow at least 40 mg is reached and then there is the evaluting side of to stay or go.
Your doc was "brave" enough to entrust giving u parnate,too bad he is not following through,im afriad what will happen is youll become discouraged and go off before u ever hit a high enough dose.This will be a shame.
Again i will always try to remeber to add i have troubles too,its a tricky drug,please use my info as just that,make sure actual decisions come from you.Good luck
Posted by Jedi on May 2, 2007, at 11:49:39
In reply to Re: How common is hypomania on MAOI's?, posted by Girlnterrupted on May 2, 2007, at 7:35:45
> Wow man, I am starting Nardil in 3 weeks and it's disappointing to hear that the good feeling will wear off in a few months.
>
> Did the medication stop working completely, or just the hypomania was gone? After the poop-out, was the social anxiety back?
>
> I remember having hypomania while on Celexa for a whole year. It was the best year of my whole life. It might have lasted longer if my doctor hadn't decided to switch me to Lexapro. As soon as I was switched to Lexapro, the hypomania was completely gone, and even after going back to Celexa, it never came back. It's been hell ever since. Nardil was my last hope, but now not even that.
>
> Is there anything else for atypical depression? How can there be only ONE antidepressant for it?Hi Girlnterrupted,
Do not get discouraged because of other people's reactions to a medication. IMHO(and sorry for being repetitive), Nardil augmented with clonazepam is the best combination available for treatment resistant atypical depression and social anxiety.The hypomania is not the antidepressant response to the med. It can feel good after being depressed for so long, but it can also cause a person to make bad decisions in their life. I know, because I did. I made a couple of business decisions while hypomanic on Nardil, that set me back at least five years. So be careful,the HIGH is not the response you are looking for. There are better drugs for that (did I say better, I meant worse). For atypical depression, you are on the right track.
Good Luck,
Jedi
Posted by natedog539 on May 2, 2007, at 13:53:04
In reply to Re: How common is hypomania on MAOI's? » Girlnterrupted, posted by Jedi on May 2, 2007, at 11:49:39
Jedi, You say that the hypomania wore off, but does nardil keep your social anxiety away even though the hypomania is gone. This is why I want to take it (for social anxiety).
Posted by djmmm on May 2, 2007, at 17:34:58
In reply to How common is hypomania on MAOI's?, posted by malcolm64 on May 1, 2007, at 19:07:35
> I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
>
> I'm not talking about a crazy kind of reaction, I'm referring to just a wonderful feeling of being super-relaxed and super-confident (which is the entire reason for taking an MAOI, b/c nothing else has worked).
>
> I did a year ago on Nardil. I first noticed the effect at about 45 mgs after about three weeks. But it slowly diminished to the point where the med wasn't having that effect anymore. So I stopped it (I went up as high as 90 mgs).
>
> Now I'm on Parnate (I'm on 20 mgs, but go up to 30 mgs later this week). I'm hoping that it replicates some of the superconfidence I felt while the Nardil was having its peak effect. But hopefully, it won't poop out on me like the Nardil did.
>
> I guess I'm experiencing anxiety alone just from waiting to see if the damn med is going to work.
>
> MalcolmI often felt I was hypomanic on both Nardil and Parnate, just because they seemed to work sooo well. If you take a look at many of the positive nardil posts/threads, it certainly seems like Hypomania is very common...that, or it just works VERY well for a lot of people.
Posted by Jedi on May 2, 2007, at 17:35:58
In reply to Re: How common is hypomania on MAOI's? to Jedi, posted by natedog539 on May 2, 2007, at 13:53:04
> Jedi, You say that the hypomania wore off, but does nardil keep your social anxiety away even though the hypomania is gone. This is why I want to take it (for social anxiety).
Hey natedog,
Yes-the hypomania is not the cure, it is a common side effect. PDOCs get worried when this symptom shows up. I believe that the hypomania is common because the atypical depression, which Nardil is used to treat, lies somewhere on the bipolar spectrum.Nardil is a good med for social anxiety because of it's affect on GABA. It is often augmented with clonazepam, since this benzo also affects GABA.
Good Luck,
Jedi( http://www.biopsychiatry.com/phenelzine/phenelzine-nardil.pdf )
Of the more severe side effects that have been reported with any consistency, hypomaniahas been the most common. This reaction has been largely limited to patients in whom disorders characterized by hyperkinetic symptoms coexist with, but are obscured by,depressive affect; hypomania usually appeared as depression improved. If agitation is present, it may be increased with NARDIL. Hypomania and agitation have also been reported at higher than recommended doses or following long-term therapy.
Pharmacotherapy of social anxiety disorder
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11801236
Pharmacological treatment of social anxiety disorder: a meta-analysis.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12900950&query_hl=15&itool=pubmed_docsum
Posted by malcolm64 on May 2, 2007, at 17:59:43
In reply to Re: How common is hypomania on MAOI's?, posted by djmmm on May 2, 2007, at 17:34:58
> > I'm just wondering how many people here have experienced hypomania as a result of being on an MAOI?
> >
> > I'm not talking about a crazy kind of reaction, I'm referring to just a wonderful feeling of being super-relaxed and super-confident (which is the entire reason for taking an MAOI, b/c nothing else has worked).
> >
> > I did a year ago on Nardil. I first noticed the effect at about 45 mgs after about three weeks. But it slowly diminished to the point where the med wasn't having that effect anymore. So I stopped it (I went up as high as 90 mgs).
> >
> > Now I'm on Parnate (I'm on 20 mgs, but go up to 30 mgs later this week). I'm hoping that it replicates some of the superconfidence I felt while the Nardil was having its peak effect. But hopefully, it won't poop out on me like the Nardil did.
> >
> > I guess I'm experiencing anxiety alone just from waiting to see if the damn med is going to work.
> >
> > Malcolm
>
> I often felt I was hypomanic on both Nardil and Parnate, just because they seemed to work sooo well. If you take a look at many of the positive nardil posts/threads, it certainly seems like Hypomania is very common...that, or it just works VERY well for a lot of people.Yes, but the issue for me was that it unfortunately lasted only a few weeks, then pooped out. Has yours lasted for the long-term?
Malcolm
Posted by natedog539 on May 2, 2007, at 18:18:50
In reply to Re: How common is hypomania on MAOI's? to Jedi » natedog539, posted by Jedi on May 2, 2007, at 17:35:58
so Jedi, basically it still works for your social anxiety.....right?
Posted by Jedi on May 2, 2007, at 20:37:58
In reply to Re: How common is hypomania on MAOI's? to Jedi, posted by natedog539 on May 2, 2007, at 18:18:50
> so Jedi, basically it still works for your social anxiety.....right?
Yes - Sorry for not being clear. The combination of Nardil + clonazepam still works for social anxiety after ten years. Some people have been taking it for twenty or thirty years. I am trying Parnate mostly because of the sweet carb cravings I get on Nardil, with the associated weight gain.
When I was in high school I was so afraid of rejection, I would not even ask a girl out. I had several speechs that I had to give in front of our student body, I was so scared I could feel my knees shaking. My palms used to sweat so much, I had to wipe them on my pant leg before I could shake someones hand. Many people thought I was stuck up, because I was smart but still didn't socialize.
In college I started drinking and smoking pot to be part of the group, any group. I don't recommend it. Before any kind of a party there was an event called a pre-function. This was so I could get drunk enough to at least talk. Might of acted like a complete idiot, but didn't really care. I was lucky to survive those years.
I sure wish I would have discovered Nardil and clonazepam thirty-five years ago. They sure work better than alcohol and pot. A lot of men try to cover up depression, because it still is not socially acceptable. IMHO lots of alcohoism, drug abuse and workaholism are men trying to escape depression.
After college I was lucky to find a job I was good at. For ten years I programmed computers and was a system analyst. This job was a good fit for someone like me who was not social. However, in my area of expertise, I was able to converse and pass on information without going into a complete panic state. I was what you call a workaholic, but I became very successful at my work. I still suffered from dysthymia and social anxiety.
After this I started my own business, which was the hardest thing I ever did. I quit a $60,000 per year job to get out on my own. I did very well until about six years later when my first major depression hit. There is a lot of heredity involved in the depression in my family. I have had two or three first cousins who have suicided. Most of the women have been diagnosed with depression at some time. And many of the men are alcoholics or drug abusers.
I think my depression was brought on by trying to do to much before the major depression hit. With my family histor, plus my dysthymia and social anxiety I knew it was just a matter of time. Have other people known it was coming? Anyway, I was running two businesses, had a new baby, and not enough hours in the day. I shut down. At this pointI found a good PDOC who got me on Nardil and saved my life. If the Parnate does not work, I have a stash of Nardil to get me back on level ground again.
Sorry for rambling on, maybe the Parnate is starting to work.
Be Well,
Jedi
Posted by natedog539 on May 2, 2007, at 23:45:00
In reply to Re: How common is hypomania on MAOI's? to Jedi » natedog539, posted by Jedi on May 2, 2007, at 20:37:58
thanks i appreciate the post and the hope. You talk about weight gain. I currently am playing Club Water Polo and am in the water 4-5 times a week and i work out about 4 times a week and play frisbee about twice a week. Should weight gain be an issue. Also do you suffer from insomnia? Jedi?
Posted by Jedi on May 3, 2007, at 2:05:26
In reply to Re: How common is hypomania on MAOI's? to Jedi, posted by natedog539 on May 2, 2007, at 23:45:00
> thanks i appreciate the post and the hope. You talk about weight gain. I currently am playing Club Water Polo and am in the water 4-5 times a week and i work out about 4 times a week and play frisbee about twice a week. Should weight gain be an issue. Also do you suffer from insomnia? Jedi?
natedog,
With that much activity you should not have much of a problem. I have lost serious weight while taking Nardil, but it involved at least two hours of intense exercise about six days per week.I do have insomnia on MAOIs. I believe, from the posts here, that most all users of Parnate and Nardil do. Currently I'm taking 25 to 50mg of Seroquel on a nightly basis. I'm a little groggy in the morning, but it sure is nice to get seven or eight hours of sleep. I've also used trazodone and diphenhydramine hydrochloride(Benadryl)-make sure there is nothing else mixed in. I've been on clonazepam long enough so that the somnolence effect is completely gone. However, the clonazepam still helps with my social anxiety.
Take care,
Jedi
Posted by natedog539 on May 3, 2007, at 3:08:29
In reply to Re: How common is hypomania on MAOI's? to Jedi » natedog539, posted by Jedi on May 3, 2007, at 2:05:26
Would you say the clonazepam or the nardil is helping out better with the social anxiety. Sorr for all the questions (you just seem so experienced).
Posted by Jedi on May 3, 2007, at 11:26:27
In reply to Re: How common is hypomania on MAOI's? to Jedi, posted by natedog539 on May 3, 2007, at 3:08:29
> Would you say the clonazepam or the nardil is helping out better with the social anxiety. Sorr for all the questions (you just seem so experienced).
Natedog,
I'm sure not an expert. It is hard for me to separate efficacy of the two medications because I have always taken them together. From the published research, I would say that Nardil is better. However it has a lot more side effects. The benzodiazepines are some of the safest and most efficacious medications we have for anxiety; especially as augmentors. (Many MDs would disagree with me on that last statement, especially those from the UK. I'll stand by it.)
JediPharmacological treatment of social anxiety disorder: a meta-analysis.
Blanco C, Schneier FR, Schmidt A, Blanco-Jerez CR, Marshall RD, Sanchez-Lacay A, Liebowitz MR.
Department of Psychiatry of Columbia College of Physicians and Surgeons, Madrid, Spain. cb255@columbia.eduPlacebo-controlled trials have evaluated the efficacy of several medications in the treatment of social anxiety disorder but information regarding their relative efficacy is lacking. ...
There was substantial heterogeneity across trials. The medications with largest effect sizes were phenelzine [effect size, 1.02; 95% Confidence Interval (CI), 0.52-1.52], clonazepam (effect size, 0.97; 95% CI, 0.49-1.45), gabapentin (effect size, 0.78; 95% CI, 0.29-1.27), brofaromine (effect size, 0.66; 95% CI, 0.38-0.94), and the selective serotonin reuptake inhibitors (SSRIs; effect size, 0.65; 95% CI, 0.50-0.81). ...
-------------------------------------------------------------------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.
PMID: 12607230 [PubMed - indexed for MEDLINE]
Posted by natedog539 on May 3, 2007, at 11:52:10
In reply to Efficacy of Nardil v clonazepam for social anxiety » natedog539, posted by Jedi on May 3, 2007, at 11:26:27
for me klonopin (generic) does not work near as well as xanax. It does some but maybe by does it too low. For example I took 1.5 mg today and feel alright, but still socially anxious. It seems that xanax works better for me. I hopefull am going to try Nardil though and I will ask to you klonopin with it. Thanks for all your support Jedi. I appreciate it.
nathan
Posted by natedog539 on May 3, 2007, at 21:28:58
In reply to Re: Efficacy of Nardil v clonazepam for social anx, posted by natedog539 on May 3, 2007, at 11:52:10
my last post was for Jedi.....
Posted by Jedi on May 4, 2007, at 1:37:05
In reply to Re: Efficacy of Nardil v clonazepam for social anx, posted by natedog539 on May 3, 2007, at 11:52:10
> for me klonopin (generic) does not work near as well as xanax. It does some but maybe by does it too low. For example I took 1.5 mg today and feel alright, but still socially anxious. It seems that xanax works better for me. I hopefull am going to try Nardil though and I will ask to you klonopin with it. Thanks for all your support Jedi. I appreciate it.
> nathanA lot of people on this board feel the alprazolam works better for them than clonazepam. There is even some research that clonazepam has a depressant effect. The half-life of alprazolam is somewhat shorter than clonazepam; this would make it a little more difficult to titrate off of if necessary. Many people say that getting off of clonazepam is very difficult also. Hey, if it works, let's not worry about getting off of it.
Jedi
Pharmacologic Treatments for Social AnxietyLink: http://www.aafp.org/afp/991115ap/2311.html
It is important to distinguish between the circumscribed and generalized types of social phobia before initiating pharmacotherapy, because the circumscribed type has responded to an "as-needed" schedule (typically of beta blockers), whereas the generalized type has responded better to standing dosage schedules (typically of specific antidepressants) of at least three months' duration. Although the outcome literature supports the efficacy of several agents, it does not indicate a clearly superior one. Treatment selection therefore involves matching the individual patient's preferences, symptoms and treatment goals with the relative benefits and risks of the following treatment options.
Monoamine Oxidase Inhibitors
The monoamine oxidase inhibitors (MAOIs) have performed well in clinical trials for treatment of generalized social phobia. Phenelzine (Nardil), in particular, has been tested extensively in placebo-controlled studies.1214 Open and controlled trials suggest that approximately two thirds of patients will show clinically significant improvement during acute treatment with these agents.The MAOIs have restrictions and adverse-effect risks that should be considered during treatment planning. The required low-tyramine diet, which prohibits many popular foods (Table 5), will deter some patients from accepting therapy with MAOIs. Patients risk a potentially fatal hypertensive reaction if they do not comply with the diet. Common adverse effects at therapeutic dosages (usually 45 to 90 mg per day for phenelzine) include postural hypotension, sedation, sexual dysfunction and weight gain. Some common over-the-counter medications, such as cold and cough remedies, are contraindicated in patients using MAOIs. Reversible MAOIs such as moclobemide, which do not require dietary restrictions, showed promise in early trials15 but mixed results in more recent ones,16,17 and to date they are not available in the United States.
The advantages and disadvantages of MAOI therapy for social phobia are summarized in Table 6. Although their advantages have led many to consider MAOIs an appropriate first-line treatment, their disadvantages have prompted others to relegate them to a second-line position behind the newer antidepressants.18
SSRIs and monoamine oxidase inhibitors have been shown to be effective in the treatment of generalized social phobia.
Selective Serotonin Reuptake Inhibitors
Several studies support the efficacy of selective serotonin reuptake inhibitors (SSRIs), including large controlled trials of paroxetine (Paxil)19,20 and fluvoxamine (Luvox)21; smaller controlled trials of sertraline (Zoloft)22 and fluvoxamine23 and, most recently, an open, uncontrolled trial of citalopram (Celexa).24 As a group, SSRIs have shown acute-treatment improvement rates ranging from 50 to 75 percent of patients. Relatively safe and well tolerated, SSRIs are currently considered an appropriate first-line consideration. The advantages and disadvantages of SSRI therapy for social phobia are shown in Table 6.
When used in low doses on an as-needed basis, beta blockers appear to be a clinically effective treatment for mild to moderate circumscribed performance anxiety.
Benzodiazepines
The benzodiazepines are fast-acting, well-tolerated anxiolytics that have shown efficacy in the acute treatment of social phobia, but they have also revealed some significant drawbacks related primarily to difficulties with discontinuation. Controlled studies of alprazolam (Xanax)12 and clonazepam (Klonopin)25 report acute-treatment improvement rates ranging from approximately 40 to 80 percent, with clonazepam showing more favorable results. However, standing dosages are sometimes difficult for patients to taper and discontinue without symptomatic worsening and a high risk of acute relapse.12
Posted by willyee on May 4, 2007, at 12:24:50
In reply to Efficacy of alprazolam v clonazepam-social anx. » natedog539, posted by Jedi on May 4, 2007, at 1:37:05
I think klonopin is better liked for people who benifit from mood stablizers.Klonopin when tolerated through its initial start,kinda builds a backbone that some fine they need,and others find dulling and too depressing,but it seems to be strong on both ends, a must for either.
Xanax is hard and direct,prob more helpful for people just needing to address anxiety at certain times,which it will do.
I laugh at how the xanax/klonpin scenerio kinda resmles the parnate/nardil one.Well not actualy laugh,but i think its weid how they both share the similarity differance and both have a love hate realtionship with users.
> > for me klonopin (generic) does not work near as well as xanax. It does some but maybe by does it too low. For example I took 1.5 mg today and feel alright, but still socially anxious. It seems that xanax works better for me. I hopefull am going to try Nardil though and I will ask to you klonopin with it. Thanks for all your support Jedi. I appreciate it.
> > nathan
>
> A lot of people on this board feel the alprazolam works better for them than clonazepam. There is even some research that clonazepam has a depressant effect. The half-life of alprazolam is somewhat shorter than clonazepam; this would make it a little more difficult to titrate off of if necessary. Many people say that getting off of clonazepam is very difficult also. Hey, if it works, let's not worry about getting off of it.
> Jedi
>
>
> Pharmacologic Treatments for Social Anxiety
>
> Link: http://www.aafp.org/afp/991115ap/2311.html
>
> It is important to distinguish between the circumscribed and generalized types of social phobia before initiating pharmacotherapy, because the circumscribed type has responded to an "as-needed" schedule (typically of beta blockers), whereas the generalized type has responded better to standing dosage schedules (typically of specific antidepressants) of at least three months' duration. Although the outcome literature supports the efficacy of several agents, it does not indicate a clearly superior one. Treatment selection therefore involves matching the individual patient's preferences, symptoms and treatment goals with the relative benefits and risks of the following treatment options.
>
> Monoamine Oxidase Inhibitors
> The monoamine oxidase inhibitors (MAOIs) have performed well in clinical trials for treatment of generalized social phobia. Phenelzine (Nardil), in particular, has been tested extensively in placebo-controlled studies.1214 Open and controlled trials suggest that approximately two thirds of patients will show clinically significant improvement during acute treatment with these agents.
>
> The MAOIs have restrictions and adverse-effect risks that should be considered during treatment planning. The required low-tyramine diet, which prohibits many popular foods (Table 5), will deter some patients from accepting therapy with MAOIs. Patients risk a potentially fatal hypertensive reaction if they do not comply with the diet. Common adverse effects at therapeutic dosages (usually 45 to 90 mg per day for phenelzine) include postural hypotension, sedation, sexual dysfunction and weight gain. Some common over-the-counter medications, such as cold and cough remedies, are contraindicated in patients using MAOIs. Reversible MAOIs such as moclobemide, which do not require dietary restrictions, showed promise in early trials15 but mixed results in more recent ones,16,17 and to date they are not available in the United States.
>
> The advantages and disadvantages of MAOI therapy for social phobia are summarized in Table 6. Although their advantages have led many to consider MAOIs an appropriate first-line treatment, their disadvantages have prompted others to relegate them to a second-line position behind the newer antidepressants.18
>
>
> SSRIs and monoamine oxidase inhibitors have been shown to be effective in the treatment of generalized social phobia.
>
>
> Selective Serotonin Reuptake Inhibitors
> Several studies support the efficacy of selective serotonin reuptake inhibitors (SSRIs), including large controlled trials of paroxetine (Paxil)19,20 and fluvoxamine (Luvox)21; smaller controlled trials of sertraline (Zoloft)22 and fluvoxamine23 and, most recently, an open, uncontrolled trial of citalopram (Celexa).24 As a group, SSRIs have shown acute-treatment improvement rates ranging from 50 to 75 percent of patients. Relatively safe and well tolerated, SSRIs are currently considered an appropriate first-line consideration. The advantages and disadvantages of SSRI therapy for social phobia are shown in Table 6.
>
>
> When used in low doses on an as-needed basis, beta blockers appear to be a clinically effective treatment for mild to moderate circumscribed performance anxiety.
>
>
> Benzodiazepines
> The benzodiazepines are fast-acting, well-tolerated anxiolytics that have shown efficacy in the acute treatment of social phobia, but they have also revealed some significant drawbacks related primarily to difficulties with discontinuation. Controlled studies of alprazolam (Xanax)12 and clonazepam (Klonopin)25 report acute-treatment improvement rates ranging from approximately 40 to 80 percent, with clonazepam showing more favorable results. However, standing dosages are sometimes difficult for patients to taper and discontinue without symptomatic worsening and a high risk of acute relapse.12
>
>
>
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.