Posted by Elizabeth on December 3, 2001, at 1:22:17
In reply to Re: SSRIs and MAOIs for SP, posted by PaulB on December 2, 2001, at 23:26:28
Hi Paul.
I can't say much about your combination because Zoloft is a drug that has many uses and I'm not too familiar with the over-the-counter drugs you're supplementing with (SAMe and 5-HTP).
The strategy for dealing with Zoloft poop-out is one that I have never encountered. Does it work well to keep you going? How often does the Zoloft poop out on you?
How do you think the SAMe helps you? Do you use a particular brand?
> This may not always be my combination therapy because there is clear evidence that the MAOI's are better for social phobia(my biggy)than the SSRI's.
I'm not sure there's clear evidence...but everybody seems to think so who's tried both!
> The problem is that the MAOI's are not selective and I believe that is a disadvantage.
Why would that be a problem -- why do you think that "selectivity" is necessarily a desirable thing?
As far as MAOIs go, I think that reversibility is the characteristic that makes the difference -- unfortunately, it seems to make them less powerful.
> Have you heard of augmeting Nardil; perhaps with an atypical antipsychotic or a 5-HT3 antagonist which were being investigated for social phobia a short while ago.
With atypical antipsychotics, yes (not necessarily for social phobia -- mainly for borderline personality and some kinds of depression). With 5-HT3 antagonists, no -- I don't know anybody who's found those helpful for psych disorders (except Remeron, which has so many other effects that it's hard to say whether the 5-HT3 antagonism plays much of a role).
> The problem is that the MAOI's interact with many drugs so polypharmacy with them could be dangerous and potentially lethal.
Actually, it can be done safely as long as you know what you're doing. I've combined lots of things with MAOIs, and I've always felt confident (correctly, as it turned out) that I could deal with any problem that might arise. (Furthermore, such problems were rare.) There are a few types of mechanisms that should be avoided in combination with MAOIs; as long as you know what these are and are familiar with the drugs you're taking (which you should always be, of course), you should be fine.
> But what a weapon against social phobia a selective MAOI would be, dont you think?
No. I think the RIMAs are probably about as effective as the SSRIs for social phobia, panic disorder, and depression. I don't think they have the special whatever-it-is that makes the irreversible MAOIs (Nardil especially, but also Parnate) work so well (especially for people with conditions that have otherwise been hard to treat effectively).
I am sort of interested in clorgyline -- an irreversible MAO-A inhibitor which was never marketed (AFAIK). I suspect it works about as well as the nonselective, irreversible MAOIs with about the same side effect profile.
BTW...my experience has been that the opioids work far better for social anxiety symptoms than any other drug I've tried. But my case may be complicated by Asperger's, which might make it very different from the typical case of SP. Still, I'd like to see such drugs as Ultram looked at more closely for SP -- so far, all we have to go on are case reports (albeit very enticing ones).
-elizabeth
poster:Elizabeth
thread:85575
URL: http://www.dr-bob.org/babble/20011202/msgs/85845.html