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Re: Thanks a bunch! + Q re: rsrch on Selegiline for SP

Posted by Rick on July 18, 2000, at 0:18:07

In reply to Re: Thanks a bunch! + Q re: rsrch on Selegiline for SP, posted by Sunnely on July 17, 2000, at 20:24:37

Some thoughts relating to these topics:

Solo selegiline was the second med I ever tried for social phobia, and it did nothing for my anxiety after six weeks, even after we tried several potentiating agents. It was great for cognition, wakefulness and sexual stimulation, however.

Frankly, I'm glad it failed, because that allowed me to convince my pdoc to let me try maintenance Klonopin, whose response rate in the 70%'s has never been bested in placebo-controlled studies of social phobia (Nardil came pretty close, though.) Branded Klonopin has been a benign life-saver for me. I've never developed tolerance. Indeed I discovered that LOW doses work a lot better than larger ones. Also, I have had no side effects except lasting GOOD ones since week 2 (I'm now in week 52). (Note: If anyone writes about the dangers of regular benzo use, I will refer them to a detailed response to that assertion which I wrote abou a month ago, and won't discuss it any further. Those debates simply become too time-consuming.)

-- At one point, I added a little Selegiline to the Klonopin seeking a return of the wonderful cognition, wakefulness, and sexual benefits. Those quickly returned, but so did a lot of anxiety. So it was gooodbye, Selegiline.

--I'm really happy to hear that Selegiline has helped your social phobia, Andrew! As usual, everybody's different. But I do believe you're in the minority. While the theory that social phobia is primarily dopamine-based had been gaining momentum, every medication-based study I've seen testing that theory (including a few on selegiline) has shown disappointing results. I believe the no-abstract citation cited above did NOT report that Selegiline proved effective for social phobia. There was a recent study listed in Medline testing the high-powered dopamine-agonist pergolide for social phobia. I ordered the article out of curiosity, and read that there had been no positive results among any of the sujects -- not even the usual placebo responses.

In my experience, every dopamine-based med I've taken has *increased* my anxiety in tandem with the welcome cognition effects. I began to believe *any* stimulanting med would increase anxiety. That's why I was flabbergasted (and delighted) to find that the new non-amphetamine stimulant Provigil(modafinil) actually complemented my Klonopin (and Serzone) by providing gentle stimulation WITHOUT working against the calm that the other meds produced. Provigil actually makes me MORE outgoing. (My guess is that BY ITSELF the Provigil would have a minimal-to-negative impact on my social phobia...strictly conjecture.)

-- Devil's advocate: While most of what I've seen (and personally experienced) fail to support
the dopamine connection that earlier studies suggested might exist for Social Anxiety, we need to take into account that dopamine is a VERY complex hormone, almost paradoxical in many ways. E.g., it strongly increases blood pressure at certain sites, and strongly lowers it at others. It's possible that different brain receptor sites could have very different reactions to dopaminergic activity, so I guess we can't completely rule out some kind of dopamine connection for Social Anxiety. Serotonin itself have some indirect impact on dopamine regulation, so if a certain kind of dopamine deficiency/dysfunction IS somehow related to social anxiety in many people, that could conceivably explain why SSRI's help many socially anxious people. Despite all of these possibilities, to-date I've seen no research on human subjects -- certainly not any med-based research -- clearly supporting dopamine deficiency/dysregulation as the driving factor in Social Anxiety.

-- While I'm not sure about Amisulpride, etc., most evidence and research suggests that serotonin syndrome (especially beyond very mild cases) from mixing low-dose Selegiline with other meds is extremely rare. Search Medline for "citalopram and selegiline" and you'll find a study supporting the general safety of this combo. (Citalopram is Celexa, the most purely serotonergic of all SSRI's.) There are other, smaller-scale studies (you can find the abstracts in Medline) that suppport the general safety of this combo. There are, as printed in a post above, some cautionary abstracts as well -- especially early ones -- but they are very much in the minority.

In fact, here's something which I found kind of amusing: As usual, the Celexa monograph sternly warns against taking any kind of MAOI concurrently. But on the "professionals" section of their own website (, they have a link to a Geriatrics journal Parkinson's-care article stating that low-dose selegiline and SSRI's are routinely prescribed together, and that problems are very rare (and usually mild and reversible in the few cases where they do occur). I was going to include the link here, but I see that the journal now requires that you sign up ($$$) for limited or long-term access before viewing the article.





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